It is Wednesday, December 4, at 2pm. The bitter taste of violence can be felt deep into the wards of Moyale District Hospital.

Although this is the one place that should remain open in the war torn town to nurse the injuries of the casualties, the hospital is shut.

Only a few patients who are in critical state are trapped in the wards as heavy gunfire rages on less than 5km away.

The fighting has been going on for more than six months now. But today is the peak. A woman who goes into labour will be on her own.

Last night, we witnessed a woman who had developed false labour turned away.

About 57 nurses, among them birth attendants, have fled to Ethiopia for safety, leaving patients on their own. Even the only X-ray technician at the hospital was gone.

Violence and strikes by health workers are some of the main reasons that lead to shutdown of health facilities in Kenya.

According to the latest Kenya Health Demographic Survey (KDHS) 2008-2009 , ‘facility not open’ is one of the ten reasons women in Kenya give for not delivering in a health facility. Other reasons include high hospital costs, long distance form facilities and poor quality of service.

But the reason notwithstanding, the absence of skilled assistance during childbirthis the most important reason why maternal deaths remain stubbornly high in Kenya, dragging the country further back as it strives to attain of the eight millennium development goals.

Millennium development goals (MDGs) are globally agreed targets by 191 United Nations member states to be realised by 2015 to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women.

The fifth goal was to reduce by three quarters the maternal death rate between 1990 and 2015.

“Close to 80 per cent of all maternal deaths can be averted if women received timely and appropriate medical care,” Mr Japheth Mati says in his paper that discusses ways of achieving improved maternal health in Kenya.

MDG4: Reducing under five deaths
Under five mortality rate out of 1,000 live births
Proportion of 1 year old immunized against measles percentage
Infant mortality rate per 1,000 live births
MDG5: Reducing maternal deaths
MDG6: No new HIV infection
Antiretroviral therapy coverage (% of people with advanced HIV infection)
Malaria incidence 2009-2012

Mr Mati’s paper published at the Africa Health Dialogue is among an ocean of analysis that have concluded that Kenya has a long way to go.

In 1990, 400 women died while going through pregnancy and childbirth for every 100,000 live births.

This number increased to 460 in 1988 before hitting its peak at the turn of the century when 490 women were dying. Things began changing in the following ten years, but at a much slower pace than had been hoped.

In 2010, the number of died of pregnancy related complications had dropped to 360. Even with the decline in the number of deaths, it is now accepted that Kenya will not hit the target of 100 for every 100,000 live births set in the year 2000 in the remaining 700 days.

By 2009, only 43.8 per cent of all births were attended by skilled health personnel in Kenya. This is less than half of the target of 90 per cent due in two years.

A deeper analysis of this data reveals that if Kenya ensured that just half of deliveries happened with the assistance of skilled birth attendants, then 47 more lives would be saved for every 100,000 live births.

If this rises to 60 per cent, then 123 more lives out of every 100,000 women in maternity would survive.

Poor prioritisation in addressing causes of under five deaths is the reason why Kenya will also miss out on reducing child deaths as spelt out in the MDG four. "Kenya is likely to miss the targets of all the MDGs as policies that have been put in place have not been implemented well," states the Global Monitoring Report, 2013.

A visit to Turkana County laid bare just how Kenya has failed in dealing decisively with malnutrition and diarrhoea, which are top contributors to deaths of children under the age of five.

A joint nutrition survey by the Government and the United Nations Children’s Fund in the county in 2012 reveals that one in three children under the age of five is stunted ΜΆ too short for their age. Stunting is a brutal condition that undermines progress for children. If stunting is not treated before the child is two years it may lead to irreversible brain and body damage.

The county director of health in Turkana, Dr Steven Ekitela, says that the county’s department of health has no budget at all, for nutrition, let alone diarrhoea, which is endemic in the county.

“We are just preparing something right now for an emergency, but we don’t even know whether we will be given the money or not,” he says.

There are many factors including poverty, over-reliance on donor funds to support food security programmes and lack of efficient service delivery systems contribute to Kenya’s failure to meet the MDGs.

“At the national level, people come up with policies and make plans on what they want to achieve. But the people at the grassroots are not given a platform to implement all that. These include resources and infrastructure,” Ekitela explains.

“At most times the government also relies on partners and NGOs because it does not have the money.” This situation limits the Government ability to set the agenda and delivery its promises in the long-term.

Compared to her neighbours, Kenya’s annual rate of reduction of under five deaths is much slower. Over the years, the death of children, under the age of five has dropped three times faster in Uganda and Rwanda than Kenya’s, while that of Tanzania’s is four times faster than Kenya.

All these countries had high numbers of under five deaths in 1990 compared to Kenya, when the journey to the millennium development goals started.

Ethiopia has already met its child death rate target of 68, while Tanzania, Rwanda and Uganda are closing the gap.

The case is the same for millennium goal number six, whose target is to have halted by 2015 and begun to reverse the spread of HIV.

Though significant gains have been made towards the attainment of this goal, the battle is far from over.

In Kenya, the numbers of new HIV infections continue to decline and more people than ever are living with HIV due to fewer AIDS-related deaths.

But factors like the low knowledge of HIV transmission among young people and condom use have put breaks on this fight.

Hope in the struggle