The Reduction of Maternal and Neonatal Mortality Programme (MNH Programme) in Kenya aims to reduce delays in mothers and newborns receiving good maternity care. The three main problems the programme seeks to address are: 1) delay in decision to seek care; 2) delay in reaching care; and 3) delay in receiving care.

The midterm evaluation documented many positive changes in community attitudes, the use of health services, and in obstetric outcomes in the programme counties. Because of the late start of the MNH Programme, however, these changes could not be directly attributed to programme activities.

The overall MNH Programme approach to improving the quality of maternity care by focusing on the health facilities that provide most of the deliveries is appropriate and efficient. However, it leaves out many smaller health centres that provide a major amount of antenatal care. A further limitation of the MNH Programme has been its predominant focus on public sector health facilities. Support to private and faith-based facilities should be considered.

The close contact of the Maternal and Newborn Initiative (MANI) with county authorities in Bungoma County has resulted in a cohesive operational programme with the ability to introduce interventions efficiently. The mode of delivery differs significantly from that in counties under the UNICEF programme mandate. UNICEF-supported counties are more complex dealing with many different sub-contracted partners which is less successful but more sustainable.

The main needs for health systems strengthening identified by the midterm evaluation in all counties are the development, planning and mobilisation of human resources, the assurance of stable and adequate financing of maternity services, and the provision of appropriate infrastructure.

The midterm evaluation found that the evaluation methodology of documenting changes at county and sub-county level was not appropriate for the programme in Nairobi. Hospitals and health centres are in close proximity, and clients do not seek care within the geographic and political boundaries of their communities. For further evaluation activities, a different approach for Nairobi will be proposed and negotiated.