Abstract
ObjectivesEffective coverage (EC) is a measure of health systems’ performance that combines need, use and quality indicators. This study aimed to assess the extent to which the Kenyan health system provides effective and equitable maternal and child health services, as a means of tracking the country's progress towards universal health coverage.Methods and resultsThe Demographic Health Surveys (2003, 2008–2009 and 2014) and Service Provision Assessment surveys (2004, 2010) were the main sources of data. Indicators of need, use and quality for eight maternal and child health interventions were aggregated across interventions and economic quintiles to compute EC. EC has increased from 26.7% in 2003 to 50.9% in 2014, but remains low for the majority of interventions. There is a reduction in economic inequalities in EC with the highest to lowest wealth quintile ratio decreasing from 2.41 in 2003 to 1.65 in 2014, but maternal health services remain highly inequitable.ConclusionsEffective coverage of key maternal and child health services remains low, indicating that individuals are not receiving the maximum possible health gain from existing health services. There is an urgent need to focus on the quality and reach of maternal and child health services in Kenya to achieve the goals of universal health coverage.
Highlights
Since the 58th WHO Assembly resolution [1] and the 2010 World Health Report [2], there has been increased focus on universal health coverage (UHC) – defined as a situation where the entire population has access to needed healthcare services, of good quality to be effective, without undue financial hardship [1, 3]
Other initiatives include the civil servants’ health insurance scheme introduced in 2012, which provides comprehensive cover to all civil servants and their dependents, and a full health insurance subsidy for the poor, elderly and disabled population through the National Health Insurance Fund (NHIF). While these initiatives are important developments for Kenya, they largely focus on providing financial risk protection which is of no value unless good quality services are accessible when needed
Data were obtained from two sets of nationally representative surveys: the Kenya Demographic and Health Surveys (KDHSs) [15,16,17] and the Kenya Service Provision Assessment (KSPA) Surveys [18, 19]
Summary
Since the 58th WHO Assembly resolution [1] and the 2010 World Health Report [2], there has been increased focus on universal health coverage (UHC) – defined as a situation where the entire population has access to needed healthcare services, of good quality to be effective, without undue financial hardship [1, 3]. Other initiatives include the civil servants’ health insurance scheme introduced in 2012, which provides comprehensive cover to all civil servants and their dependents, and a full health insurance subsidy for the poor, elderly and disabled population through the National Health Insurance Fund (NHIF). While these initiatives are important developments for Kenya, they largely focus on providing financial risk protection which is of no value unless good quality services are accessible when needed. The large list containing more than 100 indicators has
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