The Maternal, Newborn and Child Health Bill (Senate Bill No. 17 of 2023)

REPUBLICOFKENYA

PARLIAMENT

SENATEBILLS

(Bill No. 17 of 2023)

THE MATERNAL, NEWBORN AND CHILD HEALTH BILL, 2023

(A Bill published in the Kenya Gazete Supplement No. 63 of 5h May, 2023 and passed by the Senate, with amendments, on 8th October, 2024.)

THEMATERNAL,NEWBORNANDCHILDHEALTHBILL,2023

ARRANGEMENTOFCLAUSES

PART1-PRELIMINARY

Clause

• Short title.

• 2 Interpretation.

• 3 Objects.

• 4 Principles for service delivery.

PARTII—MATERNAL,NEWBORNANDCHILDHEALTH SERVICES

• 5 Right to health services.

• 6 Services for a non-pregnant woman.

• 7 — Services for pregnant woman.

• 8 — Services in the neonatal period and children up to twelve years.

• 9 一 Servicesforwomenwithspecial needs.

• 10 Courteous treatment.

• 11 一 Access to health services.

PARTIII-ROLEOFTHENATIONALGOVERNMENT

• 12 Role of the Cabinet Secretary.

• 13 Report to Parliament.

PARTIV-ROLEOFCOUNTYGOVERNMENTS

• 14— Functions of the county executive committee member.

• 15 Countygovernmentcollaboration.

• 16 Awareness andpublicparticipation.

• 17 Publication of information on maternal, newborn and child health.

• 18 一 Financing of maternal, newborn and child health services.

• 19 Annual reporting by the county executive committee member.

PARTV-MONITORINGANDEVALUATION

• 20 Identification and interventionsfor vulnerablegroups.

• 21 Monitoring and evaluation.

• 22 Quality assurance.

PARTVI-GENERALPROVISIONS

• 23 一 Maintenance of register.

• 24 Procedures, standards, ethics and guidelines.

• 25 Regulations.

• 26 Amendment to section 226 of Cap.63.

• 27 一 Amendment to section 2 of Cap. 258A.

• 28 一 Amendment to section17 of Cap.258A.

THEMATERNAL,NEWBORNANDCHILDHEALTHBILL,2023

A Bill for

ANActof Parliament toprovidefor a coordinatedsystemfortheprovisionof quality maternal,newborn and child health services; to provide for response to maternal and childmorbidityandmortalityin the country;to provide for a health care system that facilitates thc attainment ofhealth rights for mother and child; and for connected purposes.

ENACTED by Parliament of Kenya, as follows-

PART1-PRELIMINARY

Short title.

1. This Act may be cited as the Maternal, Newborn and Child Health Act,2023.

Interpretation.

• 2.In this Act-

"adolescent” means a person aged between ten and nineteen years;

"at risk persons’ means a person susceptible to mistreatment or neglectbecauseof theirinabilitytoobtainservicesnecessaryfor theirown health, safety or welfare due to age or disability;

"Cabinet Secretary” means the Cabinet Secretary responsible for health;

"community health promoter” has the meaning assigned to it under section 2ofthePrimary Health Care Act;

ActNo.13of2023

"consent” means the voluntary agreement by a patient to undergo a specificmedicalprocedureor treatment afterbeingfullyinformedof the risks, benefits, alternatives and potential outcomes;

"county executive committee member”’ means the county executive committec member responsible for health in the respcctive county;

"child" has the meaning assigned to it under section 2 of the Children

Act;

"health care provider”' has the meaning assigned to it under section 2 of the Health Act;

Cap. 241.

“intersex child" means a child with a congenital condition in which thebiologicalsexcharacteristics cannotbeexclusivelycategorised in the commonbinaryoffemaleormaleduetoinherentandmixedanatomical patterns which could be apparent prior to, at birth or in childhood;

"intra partum care'” means the correct diagnosis of child birth, appropriate examinations,screening for and management of childbirth and thecomplicationsduring theperiod fromthestartof thechildbirthto expulsion of the placenta;

Article 260of the Constitution;

"maternal" means relating to, belonging to, or characteristic of the health of a woman during her pregnancy, childbirth and the period ending forty two days after childbirth;

"National Social Assistance Authority” means the National Social AssistanceAuthority establishedunder section 3of theSocialAssistance Act;

Cap. 258A.

"neonate” refers to a child from birth until twenty eight days of life;

"person with special needs"means anindividual with additional health needs and who requires assistance above the regular health needs of the general population occasioned by physical, medical, mental, psychological or financial challenges and includes a person from a marginalised area, registered refugee and internally displaced person; and

"postpartum care"means the care and services offered toa mother immediatelyafter childbirth and endingfortytwodays afterdeliverywith a focus to promoting recuperation and ensuring restoration of health of the mother while preventing ill-health andincludes thescreening for and management of complications.

Objects.

3. The objects of this Act are to --

Principles for service delivery.

• (a) provide a framework for the delivery of comprehensive quality health services to meet the health needs of mothers, newborns and children;
• (b)establishacoordinatedandstructuredsystemfor the provision of qualitymaternal,newborn and child health carc services;
• (c) provideaframeworkthatisresponsivetocausesof maternal, newborn and child morbidity and mortality;
• (d) ensure that maternal,newborn and child health care interventions,services and supplies are available and accessible to thepublic;
• (e)establishprogramstoexpandandimprove availabilityand accessibility of maternal, newborn and child health services;
• (f) promote linkages among existing programs to expand and improve the availability of, and access to, comprehensive community maternal, newborn and child health services;
• (g)promotetheprovisionofpropercareandassistanceto mothers,newborn children and children with special needs tobecomeproductiveindependent contributorstofamily and communitylife;
• (h)promotethe utilisationof maternal,newborn andchild health services; and
• (i)promoteinnovative, comprehensive andintegrated approaches to the delivery of maternal, newborn and child health services.

4. A person shall, in the performance of their functions under this Act, be guided by the following principles —

• (a)universal accessandequityin thedeliveryof health services and the recognition of persons with special needs;
• (b) availability and access to services and timely andreliable

informationnecessarytomakeaninformeddecision regarding one's health and treatment;

• (c) coordinatedpublicparticipation 1and collaboration between the National Government, county governments and therelevant stakeholders;
• (d)equityand inclusivityin thedeliveryofhealthservices under this Act;
• (e)recognition of, and sensitivity towards,the cultures of variouscommunitiestoensurethatinterventionsare adaptable and acceptabletotherecipients;
• transparency in the implementation of programmes and activitiesin thedeliveryofmaternal,newborn andchild healthservices;
• s for both at risk persons and persons with special needs through the implementationofStatesponsored programmes;
• (h) access to safe and affordable family planning services for womenand1 menincluding accessto adequate information to enable them tomakeinformed choices on family planning;
• G ensure ethatinterventionsarebasedonobjective information and methods,and monitoring mechanisms and regular evaluations are cstablished, thus ensuring transparencyinthepublicmanagementandsocialaudit and that the needs of the population are taken into account; and
• (j)continuous improvement and themonitoring and evaluation of policies,strategies and plans related to the provision of maternal,neonatal andchild healthservices underthisAct.

SERVICES

Rightto health services.

• 5.(1) Every person has the right to the highest attainable standard ofmaternal,newborn and child health services including theright to——

• (a) timely and appropriate health care;

• (b) reasonable and affordable fee, if any, for health services and which does not impede access tohealth care;

• (c) treatment with dignity, respect and privacy;

• (d) treatment with respect and the provision of information necessary to make informed decisions;

• (e)be free from non-consensual medical treatment and experimentation;

• (f)emergency treatment and essential medicines;and

• (g)thebest attainablestateofphysicalandmcntal health

• (2) The right to health shall include the progressive access to promotive, preventive, rehabilitative and curative care.

• (3) For the enjoyment of the right to maternal, newborn and child health, the National and county governments shall —-

• a) respect, protect and fulfil the right to maternal, newborn and child health and guarantee mechanisms for its enforcement;

• (b) putin placemechanisms thatensurethe availabilityof the infrastructure and facilities necessarytoensurethe effectivedeliveryofhealthservicesattheNationaland countylevels of government;

• (C) putinplacemeasurestofacilitateaccesstomaternaland childhealth services including accesstohealthfacilities, mobilehealth services and e-health services;

• (p formulate and implement the family support programme

andother appropriateprogrammestargeting

• (i)marginalised communities and thosewho are unableto access hospital facilities within the county; and

• (ii)at risk persons andpersons withspecialneeds requiringhealth servicesunder thisAct;

• e) put in place strategies and the necessary facilities to ensure thecontinued effective deliveryof maternal, newbornandchildhealthservicesincludinginremote areasand duringapandemic or disaster;

• (f) ensure provision of specialized services and facilities for personswith spccial needs;

• (g) ensuretheavailabilityandadaptabilityofhealthcare interventions toensurethat theyarechildfriendly and sensitive to the culturalsettings ofthevarious communities;

• (h) traintraditionalbirth attendantsandintegratetheminthe delivery of prenatal, postpartum and neonatal health care;

• (i monitor and evaluate strategies and programmes for the realisation of the right tobefreefromhunger and the right to adequate food; and

• putinplace thenecessarystructures to enablemembers of the public and the existing community health workforce to develop the understanding, skills and capacity necessary for achieving equitable andeffectiveparticipationin the formulation, implementation and monitoring of any policies, strategies or programme interventions aimed at realizing the right to maternal, newborn and child health.

Servicesfor a non- pregnantwoman.

• 6.(1)A woman who is not pregnant is entitled to the following services that relate to the occurrence and course of future pregnancy——-

• (a) family health education;

8

Services for pregnant woman.

Cap. 141.

• (b)preconception care services, including hormonal profiling and the provision of prenatal vitamins, as maybeprescribedfromtime totime;
• ? appropriate counselling services may be prescribed by the Cabinet Secretary;
• (d)health information and education; and
• ? referral toadoption servicesthat complywithPart XIV of the Children Act.
• (2) The Cabinet Secretary may prescribe standards for the effective delivery of services regarding the safe occurrence of future pregnancy.
• 7.(1) The Cabinet Secretary shall put in place measures to ensure s r ss optimal healthconditionsfor thewoman andeveryfoetusthroughout the pregnancy and after the birth of the child.
• (2) Thehealth services under subsection (1) shall include--
• (a) early detection of pregnancy;
• (b) free prenatalcare as maybe prescribed by the Cabinet Secretary;
• ? referral to childbirth preparation classes as desired;
• (d) referraltoadoptionservices atan adoptionsociety registered under section 208 of the Children Act;
• e health care services in theintrapartum period;
• f healthcareservicesduringthepostpartumor postnatal period;
• g) mentalhealth care servicesfromprenatal to twelve months after birth;
• (h) training in the feeding and care of infants including breastfeeding support practices; and

• any other services relating toprenatal,intrapartum andpostpartumperiod that maybeprescribed.

• (3) The Cabinet Secretary may, for purposes of subsection (1), prescribe standards and guidelines for the provision of maternity health careservicestopregnantwomen.

Services in the neonatal period and children uptotwelve years.

• 8.(1)Everyhealth careprovider shall provide to a child from the time of birth to the age of twelve years--

• (a) comprehensivenewborncareincludingpostnatalfollow up asmaybeprescribed;

• (b) health services that ensure child survival, growth and development 1 including optimal child nutrition, childhood vaccination, growth promotion nand monitoring, developmental promotion and monitoring and childprotectionservices;

• (C) comprehensive assessment, diagnosis, treatment, rehabilitationorreferralandfollow-upasmaybe prescribed;

• (d) immunizationsin accordance with theprescribed standards and guidelines;

• (e) assessment,counselling and anticipatoryguidance with referrals and follow-up as needed regarding child development, behaviour counselling and support servicesthatmayberequiredbychildrenwithchronic illnesses or disability; and

• ( anyotheressentialhealthservicethattheCabinet Secretary may prescribe.

• (2)Where the child under subsection(1)is severelymalformed at thetimeof birth,thehealth careprovider mayrefer the child to a relevant medical practitioner for comprehensive assessment, diagnosis and treatment.

• (3)Where the child under subsection (1) has special needs,the health care provider shall cnsure that the child receivcs--

• (a) health care services, as may be prescribed, that are responsive tothe needs of a child with the relevant special needs; and
• (b) respectful and dignified care.

(4)A health careprovider shall notprovidehealth care services to the child under subsection (1)unless thehealth care providerhas obtained consent from the parent or guardian of the child.

• (5) The consent under subsection(4) shall not be required where—

2. (a) there is a documented report of child abuse by the parent or guardian who is required to provide conscnt; 3. (b) the parcnt or guardian required to provide consent practises religious or cultural practices that risk the health of the child; or 4. (c)theparentor guardianrequired toprovideconsent has been diagnosed with mental incapacity.

• (6) The Cabinet Secretary shall--

6. (a) prescribestandardsfor thedeliveryof theneonatal and child care services tothevarious categories of children uptothe ageoftwelveyears;and 7. (b) prescribe guidelines and standards for the provision of thehighestavailablestandardsofhealthservicesthat are responsive tothe needs of children with special needs.

(7) The Cabinet Secretary shall,in prescribing the standardsunder subsection (6), take into account the requirement for parental supervision and consent prior to provision of neonatal and child services.

(8)For purposes of this Act, a child with special needs includes a child with disability,a child with mental illness and a child in a marginalized area.

Servicesforwomen with special needs.

9.(1)The Cabinet Secretary shall put in place mechanisms to ensurethatwomenwhoarepregnant andwhohavespecialneedsreceive

• (a) appropriatepregnancyrelatedservicesasmaybe prescribed;

• (b) maternal health services that areresponsive to theneeds of pregnant women with special needs;

• ? diagnosisandtreatmentorreferralandfollow-upof mental health problems,both acute and chronic, including emotional and learning disorders,behavioural disorders, alcohol and drug related problems, and problems with family and peer group relationships;

• (d) in the case of pregnant adolescents---

• (i) adolescent friendly health services; and

• (ii) counsellingand anticipatoryguidancewithreferrals andfollow-upoftheadolescentwoman 1or guardian as may be appropriate;

• (e) in the case of women with disability, disability friendly health services; and

• respectful and dignified care.

• (2) The Cabinet Secretary shall, for purposes of subsection (1), put in place strategies and plans to ---

• (a) establishareferralnetworkofcommunity-bascd workers toprovide support services towomenwho are pregnant and have special needs; and

• (b) facilitatecapacitybuildingof healthcareproviderswho servewomenwho arepregnant andwho are at risk; and

• (c) ensurethatpersonswithspecialneedshaveaccessto specializedfacilitiesthat accommodatetheirneeds.

• (3)The Cabinet Sccretary shall put in place mechanisms to cnsure that adolescents undergoing postpartum care reccive counselling services toencouragethemtomaintain andcarefortheirchildren.

• (4) The Cabinet Secretary may prescribe guidelines and standards for the provision of the highest available standards of health services that areresponsive to the needs of women with special needs.

Courteoustreatment.

10. A person seeking maternal, newborn, and child health services in anyhealthcarefacilityisentitled tobetreatedwithcourtesy andrespect irrespective of their race,marital status,health status,ethnic or social origin, colour, age, disability, religion, conscience, belief, culture, dress, language or birth.

Access to health services.

11. The National Government and county governments shall, in respectof maternal,neonatal and child physical and mentalhealth care,put in placemeasures tofacilitate the provision of

• (a) reasonable maternal, neonatal, and child health carc services;

• (b) prenatal, intrapartum and postpartum health services;

• ? emergencyorambulanceservices;

• (d) counselling services for pregnantwomen whointend or are considering not carrying their pregnancies to term;

• (e)post abortion health care services;

• counselling services for adolescentsundergoingpostpartum caretoencouragethemtomaintainandcarefor their children;

• g) human resource for maternal,newborn,and child health services;

• (h) essential supplies, commodities and equipment for maternal, newborn, and child health services;

• (i)facilities that promote the safety of newborn children in

health institutions;

• lifesaving commodities for maternal,neonatal and child health services;and
• (k) the infrastructure necessary to support the delivery of basic and comprehensive emergency obstetric and neonatal care services.

PARTIII-ROLEOFTHENATIONALGOVERNMENT

Role oftheCabinet. Secrctary.

• 12.The Cabinet Secretary shall, for the effective performance of thefunctionsof theNational Government under section11—

• (a) develop a comprehensive national policy, strategies and plan of action on maternal,newborn and child health care topromote therealisation of theright tohealth;

• (b) developstandardsandguidelinesfortheeffective delivery of specialised maternal, newborn and child health services to persons with special needs;

• (c) developstandardsandguidelinesfortheeffective delivery of maternal,newborn and child health care servicesinthe country;

• (d) facilitate the coordinationofvariouspublicinstitutions andstakeholders dealingwith maternal,newborn and child health issues in the country in ensuring that adequate measures areput in place to ensure access to and the effective delivery of maternal,newborn and childhealthcareservices;

• (e) putin place thenecessaryinfrastructure and collaborate with county governments sin 1establishing and implementingan effective system ofreferralfrom one level ofgovernment to another;

• ensurethatallnationalreferralhealthfacilitiesthat offer maternal health care designate resources within therespectivefacilityfor provisionofphysicaland mentalhealthcaretowomenwhohavelostchildren

through stillbirth or during delivery;

• (g) facilitate theprovisionof mental healthcare tomaternal women in national referral health facilities;
• (h) monitor and evaluate access to, and the implementation of, policies, plans and strategies on the effective delivery of maternal,newborn and child health care services at the National and county levels of government;
• (i) foster a multi-sectoral approachbetweenthehealth and non-health sectors in ensuring access to maternal, newborn and child health care services and addressing factors that hinder the access to healthservices;
• (G) collaborate with county governments in establishing a database and e-health platform to facilitate the delivery of, and access to, health services by all persons requiring maternal, newborn and child health care services;
• (k) mobilizc resources for the effective and efficient delivery of maternal, newborn and child health services;
• (1) ensure continuous public sensitisation and capacity buildingfor efficient and effective delivery of maternal, newborn and childhealth servicesat theNational and county levels;
• (m) in collaboration with county governments, facilitate the implementation of policies and strategies aimed at reducing maternal,newborn and child morbidity and mortality in the country including-—
• (i)publiceducation campaigns onhealthy pregnancies;
• (ii)education programs for health care providers;
• (i) promotion of community support services for pregnant women;and

• (iv)promotion of physical,mental andbehavioral health during and after pregnancy,including treatment for mentalhealth disordersand substance use disorder;

• (n) undertake and facilitate eresearch 1andhealth surveillance, and implement programmes for the continuousadvancement andeffectivedeliveryof maternal, newborn and child health services;

• o) periodicallyreviewstandards,practicesandguidelines in the delivery of maternal,newborn and child care services;and

• (p) perform anyotherfunctionsthatarenecessaryfor the achievementoftheobjectives ofthisAct.

Report toParliament.

• 13.(1) Within three months after the end of each financial year, the Cabinet Secretary shall prepare and submit to the National Assembly and the Senate an annual report on the status of maternal,newborn and child health services inKenya.

• (2) A report under subsection (1) shall include

• (a)adescriptionof theactivitiesand interventionsundertaken by theMinistryinrespect of maternal,newborn and child health services;

• (b)recommendationsonlegalandadministrativemeasures requiredtoaddressspecificconcernsidentifiedbythe Ministry;

• (c)maternal and neonatal deaths recorded in each county with an analysisofroot causes andrecommendedinterventionsto address the causes;and

• (d) such other information relatingtoitsfunctions that the Ministryconsidersrelevant.

• (3) Where any recommendation contained in any previous report hasnotbeenimplemented,the CabinetSecretaryshall report toParliament onthereasonfor non-implementation and action tobetakentoimplement therecommendation.

Functions of the countyexecutive committeemember.

Cap.258A.

• (4) The Cabinet Secretary shall publish the report in the Gazette and in at least one newspaper with national circulation.

2. (5)TheNational Assembly or theSenatemay at anytimerequire the Cabinet Secretary to submit a report on a maternal, newborn and child health issue.

PARTIV-ROLEOFCOUNTYGOVERNMENTS

• 14.Each county executive committee member shall
• (a)coordinatetheimplementationofpolicyonmaternal, newborn and child health care services in the county;
• (b)facilitate community engagement and accountability in the promotion and utilisation of maternal,newborn and child health services;
• (c)implement the policies and standards on maternal, newborn and child health in the county;
• (d)establish, in collaboration with the Cabinet Secretary, an ehealth platform in the respective county for the effective delivery of matcrnal,newborn and child health carc services in the county;
• (e)liaise with the National Social Assistance Authority established under theSocial Assistance Act and suchother entities as may be necessary for the identification of, and implementation of maternal,newborn and child health programs amongst, marginalised and vulnerable groups in the county;
• (f) formulate programmes and implement strategies aimed at reducing infant mortality rates and maternal mortality ratio in the county;
• (g)implementprogrammesfortheaccelerationofinfant immunization;
• (h) develop and implement training programmes for skilled

and traditionalbirth attendants in the county;

• (i) develop and implement training programmes for the care of womenwithspccialncedsforskilledandtraditionalbirth attendants;
• G) put inplacemeasures tofacilitatetraining of health care providers in the provision of physical and mental health care services;
• (k)ensure equitable access to maternal,newborn and child health services in the county and improve responsiveness to theneeds ofthemother and the child;
• (l) ensurethat allcountyhealthfacilitiesthatoffermaternal healthcare designate resources withinthe respective facilities for the provision of physical and mental health caretowomenwhohavelostchildren throughstillbirthor during delivery;
• (m)put in placemeasure tofacilitate theprovisionofmental healthcaretomaternal womenincountyhealthfacilities;
• (n)ensure that there are sufficient ambulances to provide emergencyprenatal,postpartum and neonatalevacuation services within the county;
• (o)ensure that respectivehealthfacilities are accessible and can provide specialised care to personswithspecial needs;
• (p)facilitate community engagement in the promotion and delivery of maternal,newborn andchild healthservices in the county;
• (q)avail andput in placemeasures toimprove the quality of integrated maternal, newborn and child health services;
• (r)promotebest nutritional practices for mothers,newborns and children within the county and for this purpose, conduct sensitization programs on food and nutrition among pregnant and lactating mothers;
• (s)facilitate the training of skilled health careproviders in the

County government collaboration.

Awareness and public participation.

county in the provision physical and mental health care services;and

• (t)performsuchotherfunctionsthatarenecessaryforthe achievement of theobjectives of this Act.

15.The county executive committee member shall, for the effectivedeliveryofmaternal,newborn and childhealthservices in the respectivecounty,collaboratewiththeCabinetSecretaryandtherelevant stakeholders including —-

• (a)health care providers;
• (b) academic institutions;
• ? communityhealth promoters;
• (p) community based organisations; and
• e) religious organisations.

16.(1) The county cxccutive committee member shall promote public awareness and community participation in the formulation and implementation ofpolicies,strategies,plans and communityprograms on the provision of maternal, newborn and child health services.

(2) The county executive committee member shall, for purposes of subsection (1), ——-

• (a) developthehuman resourcesinthefield of maternal, newborn and child health services through education and training activities;
• (b) facilitatetheparticipationofcountyandcommunity health force in the provisionof human resources development activities and improving the capability of thelocalcommunityhealthworkers in theprovisionof maternal, newborn and child health care services;
• developandimplementpublicawareness and community participation campaigns targeting persons with special needs and informing them of their rights under the Act;
• (d) promoteawarenessof therightsunder thisAct andthe bodies responsible for effecting and protecting the rights;

Publication of information on maternal,newborn and child health.

• e stimulateanddirecttheparticipationof professional associations and organizations in the field of maternal, newborn and child health care services;
• promote the cooperation of health workers, community socialworkersandcommunityhealthworkersinthe provision of maternal,newborn andchild health care services;
• g monitor rand evaluatethe implementation and effectiveness of policies, strategies, programs and plans underthisAct;and
• h) ensure diversification in the conduct of maternal, newbornandchildhealthcareservicesandsensitization programmesto ensure thewidestreach towomen in the whole county.

17. (1) The county executive committee member shall design civic education programmes and, using the most appropriate means, publishinformationregardingmaternal,newborn and childhealth.

• (2)Theciviceducationprogrammesandinformationunder subsection (1) shall include ———
• (a)health complications occurring in new-borns and mothers and during pregnancy,labour,childbirth and the postnatal period;
• (b) causes of maternal, newborn and child morbidity and mortality and the danger signs;
• (c)emergency preparedness and complication readiness;
• (d) the unique health issues affecting infants born prematurely;
• (e)needsandproper careforprematurebabiesincluding methods,vaccines andother preventativemeasuresfor protectingpremature newbornsfrom infectious diseases;
• (f)information on successful breastfeeding,weaning of infants

Financing of maternal, newborn and child healthservices.

Annual reporting by the county executive committee member.

and nutritional needs of mothers, infants and children; and

• (g) the management of emotional, financial and other challenges experienced byparents and familymembers of prematureinfants and thosewithpalliative careneeds and information about community resources available for their support.
• (3) The information under subsection (1) shall-
• a) be easily accessible and published in an accessible format;
• b written in clear language to educate the public of maternal,newborn and child health issues across all residents of the county regardless of their socioeconomicstatus;
• (c) containdisaggregateddatadistinguishingbetwcen minorsfrom adults;and
• (P) wherenecessary,betranslatedto therespectivelocal languagesanddisseminatedtomediaoutletsandin outreach programmes that cater to illiterate people within the county.
• (4)In determining the information that is most beneficial to the public,the county executive committee member may consult with maternal, newborn and child health service health care providers, community organizations and otherrelevant experts.
• (5)Thecountyexecutivecommitteemembershallensure that the information is accessible to children's health providers,maternal care providers, hospitals, public health departments and medical organizations within the county.

18. Every county government shall, in its annual budget, allocate sufficient funds for the provision of maternal, newborn and child health services in the county. 19. (1) Within thrce months of the close of every financial year, the county executive committee member shall submit to the county

assembly,a report on the status of maternal,newborn and child health services in county.

(2) The report shall contain

• (a)a report onfundingofmaternal,newborn andchildhealth services in the county;
• (b)the availability and state of healthfacilities,medications and supplements relating tomaternal,newborn and child health services in the county;
• ? the number of health care providers in respective health facilitieswithin the county andmeasures taken toenhance their number;
• p maternal and neonatal deaths recorded ineach county facility with an analysis of root causes andrecommended interventionsto addressthecauses;
• e recommendations onspecific actions tobe taken in enhancing access to quality maternal, newborn and child health services in the county; and
• (f)any other information relating to maternal, newborn and child health services.

(3)Where anyrecommendations contained in anyprevious report submitted under subsection (1) have not been implemented,the county executivecommitteemember shallreport tothecountyassemblythe reasons for non-implementation and action tobe takentoimplement those recommendations.

(4)The county executive committee shall publishthe report in the county Gazette and in such other media necessary for the widest dissemination of thereportwithin thecounty.

(5)The county assembly may at any time require the county executivecommitteemembertosubmit areport on aparticularissue.

(6)The county executive member shall submit the report under subsection (1) to the Cabinet Secretary within three months of the close of everyfinancial year.

Identificationand interventionsfor vulnerablegroups.

PARTV-MONITORINGANDEVALUATION

• 20.(l) Each county executive committee member shall identify vulnerable and marginalised communities in therespective county to--
• a) identify the unique needs of the identified persons;
• (b) determine the gaps that exist in the provision of hcalth servicestothemarginalisedandvulnerablepersonsin the county;
• (c) formulate the most appropriateinterventionsnecessaryto address the needs identified under paragraph (a);
• (d) establishamechanismtoensurecontinuousservice delivery of maternal, newborn and child health services during a pandemic to theidentified persons; and
• (e) generate the information necessary todevelop and strengthen the capacity of health workers in the county to respondandaddressthehealthneedsofvulnerableand marginalised.personsunder thisAct.
• (2) In performing the functions under subsection (1), the county executivecommitteemembershall
• (a) collaborate with the Cabinet Secretary and the Cabinet Secretary responsible for social development;
• (b) systematically undertake disaggregated analysis on the existinggapsinthedelivery ofmaternal,newborn andchild health services,the levels of need and vulnerability of different groups in the county, with particular attention to assessing anyform of discrimination thatmaymanifest itself in lack of access to or marginalization in the delivery of health services among specific population groups;
• ()develop and identify correctivemeasuresfor thepurposeof addressing and preventing causes ofpoor health amongst pregnant women,newborns,lactating women and children

Monitoring and evaluation.

under this Act;

• (d)establishsystemstoensure thefeedbackofinformationin suchformats as it may consider appropriate on the delivery of health services under this Act to priority groups at the national, county and communitylevelthroughthe appropriatemedia;
• (e) establish risk management and vulnerability mapping systems;
• (f)establish and coordinatesectorspecificroles andmandates related tovulnerability and emergencyresponse; and
• (g) undertake a baseline and impact assessment at all levels of governance to guide vulnerability and emergency response.
• 21.(1) The Cabinet Secretary shall undertake annual monitoring andevaluation-
• (a)of the services rendered in the maternal, newborn and child health services in the country; and
• (b)theimplementationof andadherencetothestandards and guidelines issued under this Act.
• (2)In addition to themonitoring and evaluation under subsection (1),the CabinetSecretary shall,in collaborationwith theKenyaNational Bureau ofStatistics,undertake
• (a) a quarterly inquiry into maternal, neonatal and child deaths;
• (b)quarterlynationalmaternalmortalitydatacollectionand surveillance to identify and address pregnancy-associated deaths and pregnancy-related deaths that occur during, or within one year following,pregnancy;
• (c)in eachquarter,the collection and analysis of data on neonatal and child mortality,identify and put in place measurestoaddressthe causesforneonatalandchild deaths;

Quality assurance.

Maintenance of register.

Procedures,standards, ethics andguidelines.

• (d)studiestoidentifythedeterminantsofdisparitiesin maternal care,neonatal and child health care,health risks and health outcomes;and
• (e)the identification of groups of women with disproportionatelyhighratesofmaternalmorbidityand mortalityduetolackof accesstomaternalhealthcare servicesanddevclopstrategiesforthercductionof maternal morbidity and mortality in such groups.
• (3) The Cabinet Secretary shall ensure that the data collected under subsection (2) is disaggregated to clearly distinguish between minors and adults.
• (4)TheCabinet Secretaryshall prescribe the procedure and requirementsforundertaking themonitoring and cvaluation process.
• 22.(1) The Cabinet Secretary shall ensure the implementation andadherencetostandardsandguidelinesonqualityinmaternal, newborn and child health services in hospitals,institutions or at any facility offering maternal, newborn and child health services both at the national and countylevel inaccordancewith thenationalstandards and guidelines.
• (2)The CabinetSecretaryshall undertake continuousreviewof the standards and guidelines under subsection (1).

PARTVI-GENERALPROVISIONS

23. (1) Every hospital or approved health facility shall maintain a register, in a prescribed form, for recording the details of the maternal, newborn and childcare cases reported and dealt with in the hospital or facility.

• (2) The Cabinet Secretary shall make regulations on the form of the register to be kept and maintained under subsection (1).

24. (1) Any person, hospital, institution or health facility offering maternal, newborn and child health care services shall adhere to procedures, standards, code of ethics and guidelines as may be prescribed under this Act or any other written law.

• (2) A person offering maternal, newborn and child health care

Regulations.

services who knowingly contravenes subsection (1) commits an offence and is liable, on conviction,to a fine not exceeding five hundred thousand shillings or to a term of imprisonment not exceeding twoyears or toboth.

(3)The county executive committee member, the Kenya Medical Practitioners and Dentists Council,the Clinical Officers Council,the Nursing Council of Kenya and the Kenya Health Professions Oversight Authority shall, where they suspect a person to have committed an offence under subsection (2),refer the matter to the Directorate of CriminalInvestigationsforinvestigation.

(4)A hospital,institution or health facility offering maternal, newborn and childhealthcare serviceswhichknowinglycontravenes subsection (1) commits an offence and the members of its governing body are jointly and severally liable,on conviction,to a fine not exceeding one million shillings or to a term of imprisonment not exceedingtwoyearsor toboth.

25. (1) The Cabinet Secretary, in consultation with the Council of County Governors and other relevant stakeholders,may make regulations for the better carrying out of thisAct.

(2)Without prejudice to the generality of subsection (1),the cabinet secretary may,by regulations,prescribe minimum standards for --

• (a)the establishment of maternal, newborn and child health care premises and facilities;
• (b) notification, response and reporting of maternal and neonatal deaths;
• the delivery of programmes of maternal, newborn and child health services;
• (P) staffing in maternal,newborn and child health care facilities;
• e maternal, newborn and child hcalth care, health and safety;
• prenatal health services;
• (g) prenatal, postpartum and neonatal counselling health services;

• (h) prenatal, postpartum and neonatal check-ups and follow-ups;

• referral of persons in prenatal, postpartum and neonatal care to referral health facilities; and

• the records to be kept by hospitals and other facilities offering maternal, newborn and child health services.

• (3)For thepurposes of Article 94(6)of theConstitution

• (a) the authority of the Cabinet Secretary to make regulations is limited to bringing into effect the provisions of this Act and the fulfilment of the objects specified under section 3 of this Act; and

• (b) the principles and standards set out under the Interpretation andGeneralProvisionsActandtheStatutoryInstruments Act,in relation tosubsidiarylegislation shall applyto regulationsmade under thisAct.

Cap. 2. Cap.2A.

Amendment to section 226 of Cap.63.

• 26.Section 226of thePenal Code is amended by renumbering the existing provision as subsection (l) and inserting the following new subsection after therenumbered subsection(1)-

• (2) Subsection (1) shall not apply to a woman undergoing postpartum care under the Maternal, Newborn and Child Health Act.

Amendmenttosection 2 ofCap.258A.

• 27.Section 2of theSocialAssistance Act is amended in the paragraph immediately after paragraph (d)

(da) care and welfare of children;

Amendmenttosection 17ofCap.258A.

• 28.Section 17 of the Social Assistance Act is amended in subsection (3) by inserting the following new paragraph immediately after paragraph (b)—-

(ba) poor women caring for their children;

7heMaemalNeboand Child HeathBinl.2o3

lnf that this punted imprcion is a tue copy of the Bill as passed by the Senate on 010het.2024

Clerkofthe Senate

Endorsed for prescntation to the National Assembly in accordancc with thc provisions of standingordcr16lofthcSenatcStandingOrdcrs.

PRINTED BYTHE CLERK OFTHE SENATE

28

SpeakeroftreSenute