For many mothers in Tana River County, accessing healthcare is not a short trip to the nearest facility. It is a journey measured in hundreds of kilometres.
But the struggle does not end there. For them, especially the adolescent mothers, their hope is that when they get to the health facility, the healthcare worker will be kind to them, that commodities are in stock and that they can be able to afford services.
Tana River County Health Director Oscar Endekwa paints a stark picture of a region where geography shapes destiny.
Distance remains a major barrier. For instance, from Hola, the county headquarters, to Waldena is 132 kilometres. The impact on maternal healthcare is severe
“A lot of our population is along the river, so if you were to look at facilities in Tana river they are actually all along the river,” Endekwa says.
“If Hola Hospital is called to pick up a mother in distress in Waldena, the ambulance must travel the full 132 kilometres. If the emergency is in Kalalani, that is an additional 50 kilometres. Along the stretch from Basergasa to Garissa, there are only two facilities — Bangale and Madogo,” he paints the picture.
The adolescent girls face other barriers. Many areas lack boarding schools, making education and protection harder to guarantee.
“We know girls are safe when they are in school,” Endekwa notes, warning that limited access to education complicates health surveillance efforts.
Staffing is another strain. Some rural facilities operate with just one or two nurses.
“The distances are serving us bad. A lot of rural facilities have either one or two nurses, when we know nursing is the backbone of the health system, so if that one nurse goes on leave, you close,” Endekwa says.
Tana River borders Garissa, and the two counties share more than just a boundary; they share challenges.
For families in far-flung parts of Garissa county, access to care remains a daily challenge.
Garissa County Health Director Adan Ibrahim says national gains mask deep disparities within counties, particularly in arid and semi-arid regions.
“Kenya has made a lot of impact in achieving milestones for maternal and child health, but that notwithstanding, a lot of disparities and gaps exist within the counties.”
He cites delayed access to essential services, limited availability of medical commodities, long distances to health facilities and financing challenges that make care unaffordable for many families.
In Fafi subcounty, the scale of the problem is stark.
“If you look at a subcounty in Garissa called Fafi, it is 15,900 square kilometres, and the distance in that subcounty from one health facility to the other is around 60km, so that shows you the disparity that exists even within the county itself,” Ibrahim says.
For expectant mothers, those kilometres can mean the difference between safe delivery and life-threatening complications.
In West Pokot county, distance and tradition continue to shape the lives of women and girls.
Nancy Chebet says the challenges facing arid and semi-arid areas are deeply felt when it comes to sexual and reproductive health (SRH).
Harmful cultural practices such as female genital mutilation (FGM) and early marriages remain persistent despite years of interventions.
“For us, FGM is an issue and an aspect of early marriage. Despite the efforts that have been put in place, over time, nothing much has really changed, so this tends to increase the number of teenage pregnancies and challenges with access to service delivery,” Chebet says.
Access to emergency obstetric care is particularly strained. West Pokot, with a population of about one million people, has only two facilities offering Caesarean section services — one mission hospital and one public facility.
“You can imagine a population of one million accessing services in one facility,” Chebet says, describing the severe access gap.
With illiteracy levels at around 47 per cent, awareness and timely health-seeking behaviour remain hurdles.
Garissa, Tana River and West Pokot are among the five counties targeted with the Her Health Kenya Project (HHP), a multi-year system change project focused on advancing
equitable access to quality Sexual, Reproductive and Maternal Health (SRMH) services for
Adolescent Girls and Young Women (AGYW) in Kenya
The other two counties targeted with the project are Samburu and Homa Bay.
The National Council for Population and Development (NCPD) Director General, Mohamed Sheikh, says the five were selected because they face disproportionate burdens of teenage pregnancy, HIV infection, low
contraceptive uptake, and systemic barriers to quality health services.
“What is common about these five counties? For instance, if I pick Garissa county, Garissa is the county with the highest maternal mortality in Kenya.
More than 600,000 maternal mortalities occur in Garissa county. If you go to Samburu, Samburu is the county with the highest rate of teenage pregnancy in this country. About 50 per cent of the girls in Tana River are either pregnant or have been pregnant in their lifetime,” he explains.
“If you go to Homa Bay, Homa Bay is among the counties with the highest HIV rates, highest levels of teenage pregnancy, and also a combination of Gender-Based Violence. Tana River is also similar to Garissa, Samburu and so forth; these are remote countries, hard to reach, with little access to healthcare services. That’s why we chose five counties.”
The plan is to make sure that the services of reproductive health reach
across the mothers in those counties.
The HHP project was developed through a year-long consultative process with the National Council for Population and
Development, the Ministry of Health (Division of Reproductive and Maternal Health) and other
key stakeholders.
The initiative seeks to improve the health, wellbeing and life opportunities of
adolescent girls and young women by strengthening National and County systems that deliver
SRMH information and services over the next five years.
Through coordinated action with government, development partners, civil society,
and the private sector, the initiative aims to drive systemic and sustainable reductions in maternal
mortality and morbidity, teenage pregnancy, new HIV infections and unmet need for family
planning, while improving school retention among girls in the target counties.
The initiative supports Kenya’s commitments under the Constitution and global and regional
frameworks—including the SDGs, Agenda 2063, ICPD and FP2030—which call for equitable access
to quality sexual and reproductive health services.
Youth Voices and Action Initiative(YVAI) Executive Director Leila Abdulkeir Isaak has acknowledged that many girls continue to navigate systems that are not designed with their needs in mind.
She notes that teen girls from Madogo in Tana River, a pastoralist community, face persistent challenges accessing health services.
The young girl walks long distances to reach a health facility, yet stigma and judgment often discourage her from seeking care.
Many girls like her have limited access to accurate information about HIV and reproductive health, and very few use contraception.
Fear of being questioned or judged when asking for condoms or services forces many to remain silent — a silence that often leads to early marriage, school dropout, and lost opportunities.
Leila stressed that these outcomes are not a failure of the girls themselves, but a reflection of systemic barriers and social norms that limit their choices.
Speaking on behalf of adolescent girls and young women across Kenya, she emphasised the importance of documenting both successes and challenges through the initiative, noting that sustained investment in young women is essential to building a healthier and more equitable future.
According to the Executive Director of Reproductive Health Network Kenya Nelly Munyasia, the project will be implemented by the Ministry of Health.
“We will be looking at ensuring that the government is implementing those policies, the activities that have been set out are being implemented, and importantly, looking at where the barriers are, and what else needs to be done,” Munyasia said.
The Ministry of Health has admitted that despite progress in reducing maternal and neonatal mortality, gaps and challenges still exist.
Health DG Dr Patrick Amoth acknowledged that perinatal deaths have long been overlooked, even as the country pushes to reduce maternal mortality ahead of the 2030 global targets.
Amoth said Kenya has not given adequate attention to perinatal deaths, often treating them as minor losses.
“As a country, we have never focused on perinatal deaths. We treat them like little deaths, and the interventions that we make after have not been key areas of focus,” he said.
Dr Amoth said the Maternal and Perinatal Death Surveillance and Response (MPDSR) initiative recently launched by the ministry is as a critical step toward accountability.
“Launching MPDSR is critical to ensure that we can be able to account for all deaths, not just as mere numbers, because behind those deaths are families devastated; husbands widowed, children orphaned. We don’t want to treat this as mere statistics but as critical lessons to be able to save the next life,” Amoth said.
The ministry is also rolling out a Rapid Results Initiative (RRI) targeting 26 counties that account for 60 per cent of the country’s maternal deaths.
“If you look at a pattern of maternal mortality in this country, the national figures mask the regional disparities which have persisted ever since we got independence,” he noted.
Dr Amoth said the government will “zero in” on the 26 high-burden counties with focused interventions to reduce the maternal mortality ratio as the 2030 deadline approaches.
“We are now going to zero in on the 26 counties with 60 per cent
burden of maternal mortality to be able to clearly put interventions in place
that can make us move and reduce the maternal mortality ratio as the clock
ticks towards 2030, a mere four years away.”
Health outcomes in Kenya remain deeply segmented, with KDHS 2022 data revealing that counties such as Garissa, Homa Bay, Samburu, Tana River, and West Pokot continue to face significant challenges in HIV education, contraceptive accessibility, and maternal health support.
For instance, while Homa Bay leads significantly in education, with 51.1 per cent of residents possessing comprehensive HIV knowledge, other regions are struggling.
Garissa presents a critical concern; only 15.1 per cent of its population has comprehensive knowledge, and just 26.1 per cent are aware that condoms prevent HIV transmission.
Despite these knowledge gaps, HIV testing remains relatively consistent across all regions, peaking at 74.1 per cent in West Pokot.
The data regarding teenage pregnancy and contraception reveals even deeper disparities.
Samburu faces the highest rate of teenage pregnancy at 8.7 per cent, while simultaneously grappling with a high unmet need for contraception (14.4 per cent).
The most alarming figures come from Garissa and Tana River, where modern contraceptive use sits at a mere 0.8 per cent and 1.3 per cent, respectively.
These figures suggest that traditional barriers or a lack of access continue to hinder reproductive healthcare, even in areas where the unmet need is reported as low.