Abstract
BackgroundAntenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply- and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products.MethodsTo explore pregnant mothers’ experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre- and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants’ perceptions and experiences.ResultsFGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education.ConclusionsFuture interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.
Highlights
Antenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality
After the Safe Water and AIDS Project (SWAP) intervention infrastructure had been set up and as baseline data were being collected, we discovered that the Government of Kenya, in collaboration with a German bank, had initiated a program called Output-Based Aid (OBA) in intervention healthcare facilities in September 2013
Before conducting this qualitative study, authors had gained adequate research expertise and experience; MH had been trained in mixed-methods research, anthropology, and global health, JM had specialized in qualitative methods and anthropological research, JL was trained as a behavioral economist and had extensive research experience in western Kenya, RQ had conducted many public health intervention studies in Kenya, and RO and NA had received qualitative research methods training and had established connections with local communities through SWAP
Summary
Antenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. Antenatal care (ANC) and delivery with skilled birth attendants are known to be effective strategies to improve clinical outcomes [3] and prevent maternal and neonatal mortality [4]. Based on empirical evidence [5], the World Health Organization (WHO) has promoted the focused antenatal care (FANC) model in developing countries where pregnant mothers were encouraged to visit ANC facilities at least four times prior to delivery [6]. 43% of mothers had no postnatal checkup [2]
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 callDisclaimer: 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.
