What Kenya and Ethiopia teach us about redesigning systems for safe motherhood
Across Africa, many of the fundamentals for strong maternal and newborn health already exist—skilled health workers, trusted community networks, and proven innovations. Yet outcomes for mothers and children ultimately show whether these strengths function as a connected, responsive system, or fragment at the very moments they are needed most. According to the World Health Organization (WHO), most maternal deaths are preventable with timely care from skilled health professionals in a supportive system.
The Reality Behind the Numbers
This systemic perspective was the focus of the recent Health in Africa Webinar Series session, hosted by the Africa Health Collaborative (AHC) on January 28, 2026. In his presentation, “Improving Maternal and Newborn Health in Kenya and Ethiopia,” Dr. Henry Kilonzo of the Safaricom and MPESA Foundations argued that while we often focus on clinical outcomes, the fight for survival is often won or lost long before a woman reaches the delivery room.
WHO estimates Kenya’s maternal mortality rate at 355 per 100,000 live births and Ethiopia’s at 195—far above the Sustainable Development Goal target of fewer than 70 per 100,000. These statistics mask the daily struggles of women living far from timely, quality care. Dr. Kilonzo shared Naomi’s (name changed for privacy) story, a 26-year-old Ethiopian mother who lives three hours from the nearest clinic and often finds no medical staff available. For her, pregnancy becomes a test of distance, timing, and circumstance.
Infrastructure Must Reflect Context
Health programs often focus on building facilities, but infrastructure alone cannot overcome geographic and environmental barriers. In Kenya’s Lamu archipelago, emergency care is limited not by doctors but by tides: if a mother goes into obstructed labor at night, boats cannot transport her. The solution was a Water Ambulance system connecting island health promoters to motorized response teams, demonstrating effective interventions must be designed around local context.
Innovations that Fit Real Life
Dr. Kilonzo advocated that technology works best when it supports existing human workflows rather than replacing them. The Uzazi Salama (Safe Delivery) project in Kenya and Ethiopia paired digital tracking with a “Mama Pack” of newborn essentials, increasing facility-based deliveries by meeting mothers’ immediate needs.
This emphasis on practical, context-aware innovation is also reflected in how the AHC supports African-grown solutions like Autothermo, a wearable device for real-time newborn monitoring and A-Lite Vein Locator, a medical device that facilitates the non-invasive detection of veins under the skin.
A Call for Systems Redesign
If maternal death is a system failure, then the solution must be an intentional system redesign. Dr. Kilonzo shared real-world examples from Kenya and Ethiopia of what is possible when countries invest in a systems approach.
Kenya’s government equipped 107,000 Community Health Promoters (CHP) with medical kits and tablets to track household health and facilitate referrals. In Ethiopia, 40,000 Health Extension Workers (HEW), who are salaried female civil servants, operate out of local health posts delivering a package of 16 essential health interventions.
This focus on people-powered systems is also central to the Africa Health Collaborative’s work training over 30,000 primary healthcare workers, upskilling 60,000 professionals, and supporting 5,000 ventures to create 20,000 jobs by 2030.
A resilient system ensures complete maternal care: guaranteed transport, pre-alerted receiving facilities, and postnatal follow-up for immunization, nutrition, and support.
Dr. Kilonzo concluded: “Maternal and newborn deaths are not a technical failure—they are a systems failure. And systems can be redesigned.”
Watch the full episode here
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