Abstract
BackgroundIn 2013, Kenya introduced a free maternity policy in all public healthcare facilities. In 2016, the Ministry of Health shifted responsibility for the program, now called Linda Mama, to the National Hospital Insurance Fund (NHIF) and expanded access beyond public sector. This study aimed to examine the implementation of the Linda Mama program.MethodsWe conducted a mixed‐methods cross‐sectional study at the national level and in 20 purposively sampled facilities across five counties in Kenya. We collected data using in‐depth interviews (n = 104), administered patient‐exit questionnaires (n = 108), and carried out document reviews. Qualitative data were analysed using a framework approach while quantitative data were analysed descriptively.Results Linda Mama was designed and resulted in improved accountability and expand benefits. In practice however, beneficiaries did not access some services that were part of the revised benefit package. Second, out of pocket payments were still being incurred by beneficiaries. Health facilities in most counties had lost financial autonomy and had no access to reimbursements from NHIF for services provided; but those with financial autonomy were able to boost facility revenue and enhance service delivery. Further, fund disbursements from NHIF were characterised by delays and unpredictability. Implementation experiences reveal that there was inadequate communication, claim processing challenges and reimbursement rates were deemed insufficient.ConclusionsOur findings show that there are challenges associated with the implementation of the Linda Mama program and highlights the need for process evaluations for programs to track implementation, ensure continuous learning, and provide opportunities for course correcting programs' implementation.
Highlights
In 2013, Kenya introduced a free maternity policy in all public healthcare facilities
Our findings show that there are challenges associated with the implementation of the Linda Mama program and highlights the need for process evaluations for programs to track implementation, ensure continuous learning, and provide opportunities for course correcting programs' implementation
The following section presents study results, describing the emergence of the Linda Mama program, its implementation fidelity, and the implementation experiences from the various actors
Summary
In 2013, Kenya introduced a free maternity policy in all public healthcare facilities. In 2016, the Ministry of Health shifted responsibility for the program, called Linda Mama, to the National Hospital Insurance Fund (NHIF) and expanded access beyond public sector. An estimated 295,000 maternal deaths occurred in 2017, resulting in a maternal mortality ratio (MMR) of 211 per 100,000 live births with sub-Saharan Africa (SSA) accounting for 66% of these deaths.[1] The 2014 Kenya Demographic Health Survey reported a MMR of 362,2 which is still unacceptably high. The Kenyan health sector is financed from public, private, and donor sources accounting for 37%, 39.6%, and 23.4% of total health expenditure.[7] Household out of pocket (OOP) payments account for a large proportion (26.1%) of total health expenditure.[7] In 2018, 7.1% of Kenyan households incurred catastrophic health expenditures, resulting in 1 million Kenyans being pushed into poverty.[8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 callMore From: The International journal of health planning and management
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
