Everlyne Chepkemoi Nyangwaria Rotich

My name is Dr. Everlyne Chepkemoi Nyangwaria Rotich Bsc.N (University of Eastern Africa, Baraton, Kenya), MSN/Midwifery (University of Nairobi Kenya), PhD (University of Cape Town, South Africa). I am currently a senior lecturer at the School of Nursing and Midwifery, Moi University Kenya. I am the coordinator for Kansas University- Moi University collaboration and currently working together with KU colleagues on a COIL grant whereby we are doing virtual classroom with Moi University and Kansas University Midwifery graduate students. I am humbled having been selected as SPR 2022 KASC African Affiliate Fellow.

I have served at different capacities at Moi University including being founding chair department of Midwifery and Gender 2012-2015, School of nursing representative to graduate school, participated in development of various curricula at school of nursing and college of health sciences including, Master of Science Nursing (Maternal and Neonatal Health) curriculum, Bachelor of Science Nursing Curriculum Master of Medicine Reproductive health, Development and implementation of nursing and midwifery protocols, guidelines, courses and programs, particularly developed clinical midwifery protocols, Bachelor of Science in psychology curriculum.

I was raised as a child in a remote village where distance from home to the nearest health facility or school was over 10kms with no reliable transport and other basic amenities. Many women then in the neighborhood had their births at home attended to by traditional birth attendants or family member. Occasionally there were medical outreach programs in the nearby trading center. I walked to school barefoot. There was no piped water in the neighborhood, most families and institutions depended on boreholes and seasonal water sources.

The background stated above stimulated my passion for midwifery and supporting women to have a satisfying experience during pregnancy and childbirth. My pursuit to understand and support women to have a satisfying birth experience led me to utilize engaging approaches Appreciative Inquiry and Human Scale Development Model. The participatory nature of the Appreciative Inquiry and Human Scale Development framework promotes inclusion of consumers of the service (women) and the people who work in the area (midwives and health service managers), as they understand the environment and what is required for the system to perform optimally to build on what works well in the system (Guillen-Royo, 2010; Whitney & Trosten-Bloom, 2010). 

My PhD research “Development of Woman Centred Midwife-led Model of Care through Participatory Methods for the Uasin Gishu County Referral Hospital, Kenya” engaged women, midwives and health service managers in the development of UPENDO-S model. Acronym UPENDO-S represents: (U)User-friendliness, (P)Person (woman)-focused care, (E) Excellence in evidence-based practice, (N)Networking, (D)Dedicated supported midwives, (O)Organised care and (S) Supportive leadership. The term UPENDO means ‘love’ in the Swahili language.

FIGURE: UPENDO- S WHEEL (Rotich, E. C. (2020). Development of Woman-Centred Midwife-led Model of Care through Participatory Methods for the Uasin Gishu County Hospital, Kenya)

The model identified the main components for a satisfying fulfilling birth experience for both women and their care providers. User-friendliness recognizes personalised, responsive care, live and well mother and baby, efficiency and timeous service delivery, effective, responsive communication and compassionate, respectful care. Person (woman)-focused care considers women central to maternity services undergoing a normal physiological process and not illness. The woman’s individuality is embraced and personalised and responsive care provided. Understanding of the woman requires building of relationships and providing women with information to enable them to direct decisions on their care and support cultural sensitivity.

It entails excellence in evidence-based practises to ensuring continuity of care, achieving good maternal and neonatal outcomes, providing targeted responsive interventions and excellence in service provision. The model identifies networking, collaborations, formation of linkages and stakeholder engagement important. Recognizes importance of the involvement of the community and political leadership in decisions related to maternity care. The model identifies dedicated supported midwives educated with knowledge and skills, updates and supported and protected to maximise their skills as maternity care providers. The model recognizes competent midwives with clearly defined roles and responsibilities working within a supportive system with access to specialists to support them in case of need for referrals.  Through regulation, midwives can uphold professionalism and practice within defined professional codes of ethics and standards. It is also important that the midwives are well remunerated and deployed. It also proposes motivation and minimisation of frequent transfers of midwives and use of implementation of human resource policies and codes of ethics in managing issues related to human resource.

The model in addition delves in organisation of care that entails maintained infrastructure and essential departments, maintained clinical resources, improved hospital processes and effective systems, maintained health information systems and well-defined nature of service at the facility. Finally, this woman-centred midwife led care requires supportive leadership who are experienced focused, visionary/transformational with a capacity to make decisions. Such leaders participate in facilitative supervision, shared governance and embrace employee participation in decision-making.

My other research publications include:

• Nthiga S., Rotich E., Yego F (2020). Birth preparedness and complications readiness among primigravid women attending antenatal clinic at a County Hospital in Kenya. Kenya Journal of nursing and midwifery 5 (2), 44-52
• Mochama, R. S., Esamai, F., & Rotich, E. (2019). Outcomes for preterm babies during the neonatal period in Kisii teaching and referral hospital, Kenya. Global Journal of Health Sciences, 4(1), 1-10.
• Rotich, E., &Wolvaardt, L. (2017). A descriptive study of the health information needs of Kenyan women in the first 6 weeks postpartum. BMC pregnancy and childbirth,17(1),1-8.
• Getanda, A., & Nyangwaria-Rotich, E. C. (2017) THE SPECTRUM OF MIDWIFERY CARE.
• Rotich E., Mbai I., Marete I., Bennasar V. M., Lelong B.A.  (2012). Being Homeless: Reasons for and Challenges Faced by Homeless Women in the Streets of Eldoret Town, Kenya. African Journal of Midwifery and Women’s Health.

I have participated actively as reviewer of Abstracts for International Confederation of Midwives Conference to be Held in Bali in 2023 in 2022, Sub-Saharan Africa Faimer 2015-2018 and National Nurses Association Scientific Conferences 2004-2008. Article reviewer for African Journal of Midwifery and Women’s health 2008-2016, Editor of the procedure Manual for Nurses for the Nursing Council of Kenya 2008 and contributor to the maternal and new-born health chapters and Developed UNFPA and MAK FGM E-learning toolkit for Midwives 2016.

Additionally, I have participated in several workshops locally and internationally notable among them February 2022: Speaker at the International Conference on harmonization of Curriculum and training of Health Professionals held in Mombasa “Role of Counties in regulation and training of health care workers”, December 2021: Key Note Speech at the Annual Scientific Midwives Conference in Kakamega title “Invest in Midwives for Birth Equity in Kenya”; November 2021: Presentation of Step 10 on “Supportive Human Resource Policies” of the 12 steps to safe and Respectful Mother-Baby Family Maternity Care of International Childbirth Initiative; May 2021:  Key Note Speech at the International Interdisciplinary Research Conference Held at the University of Eastern Africa Baraton Title: “Exploring Solutions to Contemporary issues influencing the 21st century Social Fabric”; Key Note Speech at the Midwives Association of Kenya annual Scientific Conference in Kilifi Theme “Midwives Leading the Way in quality Care for Universal Health Coverage”; June 2017: Delegate Midwives Association of Kenya at the International Confederation of Midwives in the Triennial ICM Congress held Toronto Canada; December 2016: Poster Presentation on “State of Midwifery in Kenya” in Johannesburg, South Africa; October 2016: Hosted the launch of Midwives Association of Kenya in Eldoret, Kenya ; June 2015: Kenya Delegate at International Council of Nurses “Global citizen, Global Nursing” In Seoul Korea and Nov 2014: Key note speakers at the Kenya Progressive Nurses Association conference in Meru: Key Note Speech “Strengthening Nursing and Midwifery to achieve vision 2030”.

In addition to research activities, I have served at different capacities at Moi University including being founding chair department of Midwifery and Gender 2012-2015, School of nursing representative to graduate school, participated in development of various curricula at school of nursing and college of health sciences including, Master of Science Nursing (Maternal and Neonatal Health) curriculum, Bachelor of Science Nursing Curriculum Master of Medicine Reproductive health, Development and implementation of nursing and midwifery protocols, guidelines, courses and programs, particularly developed clinical midwifery protocols, Bachelor of Science in psychology curriculum.

My experience also spans in leadership and policy. I served as a County Executive Committee Member (regional minister) for the County Government of Uasin Gishu (Dec 2017- N0v 2022).  During my tenure I was able to implement key activities towards improving maternal and neonatal health and impact overall in health. Key achievements include construction, equipping and operationalization of health facilities, notably operationalization of theatre services and first ever 20 bed Intensive care unit by County Government of Uasin Gishu. Development of innovative measures to coordinate and handle emergencies, through establishment of a 24 hour call centre,  realized Improvement in Health indicators to include increase in skilled birth attendants from 67%in 2017 to 88% in 2021, proportion of fully immunized children from 75.4% in 2018 to 86.6% in 2021 and uptake of 4th antenatal care 40.2 % in 2018 to 51.5 % in 2021.Initiated measures to scale up NHIF and LINDA MAMA Rebates that realized an increase in rebates to health facilities from Kshs. 7,000,000 per annum in 2017 to over Kshs 100,000,000.00-year 2021. Guided Development of different policy documents for department of health County Government of Uasin Gishu, Initiated distribution of sanitary towels to schools in collaboration with the office of the First Lady County, Invested in development of human resource capacity initiatives,  Empowerment and development of different committees at the County Department of health, In ensuring service excellence, operational and organizational efficiency, improved quality of care, initiated measures to improve the coordination of health service delivery through,

As a CECM, I participated in development of different policy documents and guidelines for the Ministry of Health, and Council of Governors, including Kenya Health Financing Strategy 2020-2030;  Kenya Health Strategic Plan 2018-2023; Inter-Governmental Participation Agreement on implementation of Universal Health Coverage, Participated in Midterm Review of the Transforming Health Services funding programme with World Bank team, Chaired Health Care Financing, Leadership and Governance Committee of the County Executive Committee Members for Health Caucus at the Council of Governors, Co-chaired Health Care Financing Intergovernmental Technical Working Group, Representation of CECMs for Health Caucus in Reproductive maternal Newborn Child and Adolescent Health Technical Assistance Multi Donor Trust Fund (RMNCAH TA MDTF) advisory Group at world bank and Board Member AMPATH, chairperson Finance and Human Resource Committee.

Having served as Chairperson of the Nursing Council of Kenya between September 2010 to June 2015. Duties and responsibilities included: Providing oversight to the Nursing Council Nursing Council of Kenya in regulation of nursing and midwifery education and practice in Kenya, making provision for training and instruction of persons seeking registration or enrolment as nurses and midwives in Kenya, establishing and improving standards of all branches of the nursing profession and safeguard interests of all nurses in Kenya, Prescribing and Regulating syllabuses and instruction courses of training for persons seeking registration as nurses or midwives in Kenya, Directing and supervising the compilation and maintenance or registers, rolls and records for nurses in Kenya and Advising the Cabinet Secretary on matters concerning all aspects of nursing. Guided in the development of tools and systems towards cooperate Governance, competitive recruitment of CEO/registrar, institution of mechanisms for effective human resource management systems and structures, Development of strategic plan 2012-2017, Development of different syllabi including syllabi for Bsc. Nursing, and syllabi for Upgrading of KRCHN to Bsc. Midwifery. Developed tools for cost containment and risk management (audit, finance, procurement manuals) and Development and review of governance manuals (HRM manuals, legal and other instruments).

My passion is in maternal and newborn health and overarching passion towards provision of affordable, reliable, quality health services to all.