Nakuru County
Safe caesarean care that saves the lives of mothers and newborns in Kenya.
Photo by Frank Kimaro
The SURGfund-supported project “Obstetric Safe Surgery in Nakuru County” aims to improve maternal and perinatal outcomes through safe, timely, appropriate, and respectful caesarean section (CS) care for over 25,000 women giving birth each year across five facilities in Nakuru County, Kenya.
Women in low- and middle-income countries are up to 100x more likely to die following CS compared to women in high-income countries.
Nearly 50% of facility-based maternal deaths are associated with CS.
Surgical site infection occurs at a rate 5x higher in Sub-Saharan Africa than in high-income countries.
Our mission
In the countries in which we work, nearly 50% of facility-based maternal deaths are associated with CS.
In Kenya specifically, 37% of all maternal deaths are associated with CS.
We improve access to Safe CS in Nakuru County, Kenya along the entire perioperative continuum of care, including postpartum follow-up. Our model builds surgical team capacity, aiming to scale-up impact and inform policymaking to improve outcomes on a national level.
Impact
Since the launch of this project, we have improved care for over 25,000 women and their newborns in Nakuru each year.
-45%
Reduction in newborn unit admissions
+90%
Increase in early initiation of breastfeeding after caesarean
-71%
Reduction in newborn mortality
About the project
Kenya’s maternal mortality ratio of 379 per 100,000 live births has stagnated over the past two decades and is far behind SDG targets. Similarly, the neonatal mortality rate of 18 per 1,000 live births has not decreased in the past decade. The country suffers from one of the highest stillbirth rates globally at 19 per 1,000 total births. Timely access to safe CS can avert 100,000 maternal deaths every year (over a third of global maternal death) and reduce perinatal mortality by 30-70%
Yet, access to CS alone is not enough – it needs to be safe. Women giving birth in LMICs are 100 times more likely to die following CS than those in high-income countries. The most common deaths are due to haemorrhage or infection. CS maternal mortality risks have not improved in LMICs over the last 30 years. In Kenya, nearly half of facility-based maternal deaths are associated with CS, and a lack of quality, standardised clinical care has been identified in 90% of maternal deaths. In Nakuru County, where the project is located, the rate of CS is 22.9%, ranging from 21.5% to 34% across the project facilities.
Launched in March 2025, this three-year SURGfund supported project combines interventions to adapt and implement global guidelines and best practices, improve facility readiness, deploy training and mentorship, and strengthen data quality and data systems alongside the Ministry of Health. The present project builds on a model which has been successfully tested in Makueni County to scale-up impact in five facilities in Nakuru County in a hub-and-spoke model.
The training and mentoring element utilises a hub-and-spoke model across five facilities. Nakuru Provincial Hospital serves as the hub. The four spokes are the Naivasha District Hospital, Bahati District Hospital, Molo Subcounty Hospital, and Gilgil Subcounty Hospital. Following an initial three-day training for interdisciplinary surgical teams from all five facilities, we implement continued training and mentorship over the project duration. A newly established network of mentors accompanies the teams and trains the surgical team members, including obstetricians, surgeons, anaesthesia providers, scrub technicians, nurses, and midwives. AIC Kijabe Hospital supports the project with targeted training on anaesthesia care.
Through these project activities, we improve the safety and quality of pregnancy care for more than 25,000 women who give birth each year across the five facilities.
This project is funded through SURGfund, our collaborative funding platform for surgical care.
The surgical team at Nakuru Provincial Hospital
The Nakuru project will ensure an equitable and strengthened surgical ecosystem to deliver quality CS care for every woman, everywhere, every time.
Dr. Daisy Ruto
Project Director | OSS Nakuru Project, Kenya
Project partners
We work with local and international partners to make this locally led project a success.
Project team
Our team brings together local experts in Nakuru and our international team.
Dr. Daisy Ruto
Project Director, OSS Nakuru Project, Kenya
Mary Muthengi
Technical Officer, OSS Nakuru Project, Kenya
Christine Muia
Programme Manager, OSS Nakuru Project, Kenya
Samuel Kamau
MERL Officer, OSS Nakuru Project, Kenya
Gregory Sund
AIC Kijabe
Phyllis Ngure
Simulation Coordinator, AIC Kijabe
Mary Mungai
AIC Kijabe
Immanuel Mugambi
Simulation Coordinator, AIC Kijabe
Meg Bertram Robins
MERL Consultant, Women’s Health, GSF
Dr. Jean Chamberlain
Clinical Lead, Women’s Health, GSF
Dr. Mélanie Samson
Programme Lead, Women’s Health, GSF
“Your team's cultural sensitivity, professional excellence, and genuine care for our healthcare workers have created lasting bonds that transcend geographical boundaries.”
Dr. Daniel Wainana
County Director of Medical Services, Nakuru County
More of our work
Other projects funded and accompanied by the GSF.
GLOBAL · ONLINE LEARNING
SURGhub
The UN Global Surgery Learning Hub: online courses for surgical care teams, with more than 67,000 registered learners.
NIGERIA
Kano State
Safe, timely and respectful caesarean care for over 27,000 women giving birth each year in Kano State.
NEPAL
Koshi Province
Reducing deaths and complications linked to caesarean section for mothers and newborns in Koshi Province.
TANZANIA
Building Bridges for Broken Bones
Better fracture care in rural Tanzania through training and collaboration between traditional bonesetters and surgeons.
RWANDA
Breast cancer surgery
Improving outcomes for women with breast cancer in Rwanda through better training, patient navigation and data systems.
PAKISTAN · NEPAL
National surgical planning
Helping ministries of health plan how to expand access to safe surgical care, with the NSOAP Manual and country support.
PREVIOUS PROJECT
C-Safe
Developing, implementing and evaluating a strategy to reduce maternal and newborn deaths and complications following caesarean section in low- and middle-income countries.
Partner with us.
Partner with us today to accelerate access to surgical care for all women who need it.
Contact: m.samson@globalsurgeryfoundation.org