Abstract
BackgroundKenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy’s effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities.MethodsA time series analysis was conducted on health facility delivery services utilization, maternal and neonatal mortality 2 years before and after the policy intervention in 77 health facilities across 14 counties in Kenya.ResultsA statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the ratio of maternal mortality and the rate of neonatal mortality.ConclusionThe findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths.
Highlights
Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country
Initial assessments of the implementation of this policy have identified various gaps, such as drug and supply shortages, insufficient funding, skilled health care worker shortages, lack of skills among health workers, stakeholder non-involvement in the policy design, delayed reimbursement of costs incurred while providing free maternal health care, heavy workloads, health worker demotivation, healthcare worker attitudes, low privacy levels in public health facilities and unavailability of ambulances for emergencies occurring at community level [16, 17]. In light of these contextual gaps, this study aimed to investigate the effects of the free maternal health care policy in Kenya on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in public health facilities
The elimination of user fees for delivery services in Kenya resulted in a significant increase in the number of deliveries conducted in Kenyan public health facilities; this result indicates that cost may be a key deterrent to delivery service utilization
Summary
Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. Kenya joined other African countries in the abolishment of delivery fees in all public health facilities through a presidential directive signed into effect on June 1, 2013 [5]. Through this policy, public health facilities are reimbursed for costs incurred while providing delivery services through a capitation fund provided by the Ministry of Health. 2500 Kenya shillings (25 US dollars) are reimbursed for every delivery conducted in level 2 facilities (health centers) and level 3 health facilities (sub district hospitals); 5000 Kenya shillings (50 US dollars) are reimbursed for every delivery carried out in level 4 health facilities (district hospitals) and level 5 health facilities
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