Abstract
Introductionmaternal and neonatal health status indicators have steadily improved over time in Kenya. Significant challenges remain, including persistent inequities between population subgroups, and a health system that delivers variable quality care and inconsistent access to care. This paper highlights results of an ex-post evaluation to assess the impact of maternal and health systems strengthening intervention to improve newborn health outcomes in Bungoma County, Kenya, focusing on access to and quality of maternal and neonatal care.Methodsthe study design was quasi-experimental, using household surveys to assess outcomes at baseline and end-line. Stratified cluster sampling was used to identify households, based on heath facility catchment areas. Inclusion criteria were women aged 18-49. Chi-square and fisher´s exact tests were used. Patched-up design was used to compare outcomes before and after the intervention and intervention and control sub-counties.Resultsprovision of transport vouchers decreased barriers to accessto health care, resulting in an increased number of deliveries in health facilities. Women in the end-line group were 95% more likely to deliver at a health facility compared to 74% at baseline. The intervention improved potential and effective access to antenatal care as well as deliveries in health facilities. This positively impacted quality of care provision in the sub-counties.Conclusionkey elements of health system strengthening included reducing cost barriers and enhancing the capacity of the health facilities to deliver high quality care. The intervention addressed commonly identified supply-and demand-side barriers, providing stronger evidence that addressing these hindrances would improve utilization of maternal and child health services.
Highlights
Kenya is a young and growing country, with an estimated population of 47.6 million in 2019(1)
Its health indicators have steadily improved over the years, as evidenced by the 2008 and 2014 demographic survey data.[2]. This has been accompanied by its Universal Health Care (UHC) service coverage index being scored at 55, which is relatively high in the context of sub-Saharan Africa.[3]. Despite this progress, many significant challenges remain, including persistent inequities between population subgroups, and a health care system that provides variable quality and inconsistent access to care, especially for women and newborns
The Reproductive Maternal New-born Child Adolescent Health (RMNCAH) Investment Framework was launched in 2016to guide smart, scaled up and sustained financing for delivering quality RMNCAH services.[5]. More recently, the increasing focus of the Kenyan government on UHC has provided much needed attention to maternal and child health indicators
Summary
Kenya is a young and growing country, with an estimated population of 47.6 million in 2019(1). Its health indicators (such as infant mortality rate, under-5 mortality rate, maternal mortality ratio, etc.) have steadily improved over the years, as evidenced by the 2008 and 2014 demographic survey data.[2] This has been accompanied by its Universal Health Care (UHC) service coverage index being scored at 55, which is relatively high in the context of sub-Saharan Africa.[3] Despite this progress, many significant challenges remain, including persistent inequities between population subgroups, and a health care system that provides variable quality and inconsistent access to care, especially for women and newborns. The Reproductive Maternal New-born Child Adolescent Health (RMNCAH) Investment Framework was launched in 2016to guide smart, scaled up and sustained financing for delivering quality RMNCAH services.[5] More recently, the increasing focus of the Kenyan government on UHC (as one of the four pillars of its Big Four Agenda) has provided much needed attention to maternal and child health indicators. The newly created county governments often do not have the requisite technical capacity to manage devolved functions effectively, and there is lack of clarity around the roles, responsibilities and structures existing at national and county level and the flow of revenues and resources[6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
