Abstract
BackgroundGlobally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013.MethodsA qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis.ResultsFree maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy.ConclusionFree maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.
Highlights
There are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates
Kenya is evolving from a low to a middle income nation but despite this economic milestone, Kenya is still ranked among the ten countries that contribute to the 60 % of global maternal mortality – Kenya records over 6000 maternal deaths annually [3]
User fee on health care services was introduced in Kenya in 1989 as a health financing strategy [6], this strategy has since been seen to contribute to inequity in the utilisation of health care services as the poorest households were found to utilise less of the fee charging facilities compared to the rich in the society [7]
Summary
There are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. Compared to other parts of the world, maternal deaths are higher in SubSaharan Africa where approximately 165,000 women are reported to die annually due to pregnancy and its related complications [1]. Kenya is evolving from a low to a middle income nation but despite this economic milestone, Kenya is still ranked among the ten countries that contribute to the 60 % of global maternal mortality – Kenya records over 6000 maternal deaths annually [3]. User fee on health care services was introduced in Kenya in 1989 as a health financing strategy [6], this strategy has since been seen to contribute to inequity in the utilisation of health care services as the poorest households were found to utilise less of the fee charging facilities compared to the rich in the society [7]
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