Trends of utilization of free maternal services implemented among postnatal women in sub-county hospitals of selected counties in Nyanza, Kenya
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20204381Keywords:
Implementation, FMS, UtilizationAbstract
Background: Low utilization and poor accessibility of hospital based maternal services in low and middle-income countries (LMIC) are evident and financial barriers is a major bottleneck. Globally, an estimated 600,000 maternal deaths occur yearly with over 90% of these deaths occurring in LMICs. In Kenya, maternal mortality is still relatively high with 362 maternal deaths per 100,000 live births. Gaps in the quality of maternal health services exist due to high costs, poor staffing and inaccessibility. However, Utilization of hospital based maternal services enhances skilled delivery and consequently reduces maternal and child mortalities and morbidities. The aim of this study was to establish the trends of utilization of free maternal services (FMS) before and after implementation in counties of Nyanza, Kenya.
Methods: The study adopted an analytical cross-sectional study utilizing mixed methods of data collection. Secondary quantitative data on the rate of utilization between June 2011 and May 2015 was compared. Qualitative data was collected from key informants and focused group discussants. Purposive and simple random sampling were used to select target population. Data was analysed using both parametric and non-parametric statistical methods.
Results: In maternal services utilization, Kisumu county recorded the highest 98.7%. Overall, in Nyanza, there was tremendous growth on trends of FMS utilization of 53.4% from 36.7% before implementation of FMS with cases of still births, maternal deaths and neonatal deaths.
Conclusion: The upsurge of FMS utilization encouraged skilled birth attendance but also caused enormous constrains to health system and reduced the quality of FMS.
References
WHO. Trends in maternal mortality: 1990-2010. WHO, UNICEF, UNFPA & the World Bank estimates. 2012: Geveva, WHO, p59.
Zureick-Brown S, Newby H, Chou D, Mizoguchi N, Say L, Suzuki E, et al. Understanding Global Trends in Maternal Mortality. Int Perspect Sex Reprod Health. 2013;39(1)32-41.
Witter S. Health financing in fragile and post-conflict states: what do we know and what are the gaps? Social Sci Medl J. 2012;75(12):2370-7.
Witter S, Dieng T, Mbegue D, Moreira I, De Brouwere V. The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health policy plan journal. 2010;25:384-92.
Gabrysch S and Campbell OMR 2009, ‘Still too far to walk: literature review of the determinants of delivery service use’, BMC pregnancy childbirth. 2009;9:34.
Nguyen HTH, Hatt L, Islam M, Sloan N, Chowdhury J, Schmidt JO et al. Encouraging maternal health service utilization: an evaluation of the Bangladesh voucher program. Socio Sci Med J. 2012;74:989-96.
Richard F, Antony M, Witter S, Kelley A, Sieleunou I, Kafando Y et al. Fees exemption for maternal care in Sub-Saharan Africa: a review of 11 countries and lessons for the region. Global Health governance J. 2013;6:52-72.
Steinhardt LC, Aman I, Pakzad I, Kumar B, Singh LP, Peters DH. Removing user fees for basic health services: A pilot study and national roll-out in Afghanistan. Health Policy Planning. 2011;26:92-103.
Akanbiemu FA, Olumide AM, Fagbamigbe AF, Adebowale AS. Effect of perception and Free Maternal Health Services on Antenatal Care Facilities Utilization in selected Rural and Semi-urban communities of Ondo State, Nigeria. Bri j med medical Rese. 2013;3(3):681-97.
Campbell J, Oulton JA, McPake B, Buchan J. Increasing access to ‘free’ health services: are health workers not a missing link? Int J Clin Pract. 2011;65:12-5.
Dzakpasu S, Powell-Jackson T, Campbell OMR. Impact of user fees on maternal health service utilization and related health outcomes: a systematic review. Health policy and planning j. 2012;29:137-50.
Ridde V, Morestin F. A scoping review of literature of the abolition of user fees in healthcare services in Africa. Health Policy Planning J. 2011;26:1-11.
Ponsar F, Van Harp M, Zachariah R, Gerard S, Philips M, Jouquet G. Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali. Health Policy Plan J. 2011;26:72-83.
Ridde V, Richard F, Bicaba A, Queuille L, Conombo G. The national subsidy for deliveries and emergency obstetric care in Burkina Faso. Health Policy Plan J. 2011;26:30-40.
Nimpagaritse M, Bertone MP. The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy Planning J. 2011;26:63-71.
Kohler PK, Chung MH, McGrath CJ, Benki-Nugent SF, Thiga JW, John-Stewart GC. Implementation of free cotrimoxazole prophylaxis improves clinic retention among antiretroviral therapy-ineligible clients in Kenya. AIDS J. 2011;25(13):1657-61.
Langat E, Mwanri L. Healthcare service provider’s and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study. J Reprod Health. 2015;12(59).
WHO, UNICEF and UNFPA. The World Bank: Maternal mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva.2012
Bongaarts J.WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Trends in Maternal Mortality: 1990 to 2015 Geneva: World Health Organization, 2015,” Population and Development Review. 2015;42(4):726.
WHO, UNICEF, UNFPA, World Bank Group and UNPD estimates, 2015. Trends in Maternal Mortality:1990 to 2015.
Ziraba AK, Mill S, Madise N, Saliku T, Fotso JC. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey. BMC Health Services Res. 2009;9:46.
De brouwere, V, Richard F, Witter S. Access to maternal and perinatal health services: lessons from successful and less successful examples of improving access to safe delivery and care of the newborn. Tropical Medicine and International Health. 2010;15:901-9.
Maru AS, Chutiyami M, Shagari NB. Exploring challenges in decreasing maternal mortality in Africa with respect to failure to achieve Millennium Development Goals (MDGs). J rese nursing midwifery. 2016;5(3):63-9.
Essendi H, Samuel M, CFotso, J. Barriers to Formal Emergency Obstetric Care Services ‘Utilization. J Urban Health. 2011;88 (2):356-69.
Galadanci HS, Idris SA, Sadauki HM, Yakasai IA. Programs and policies for reducing maternal mortality in Kano state, Nigeria: a review. (special issue: reducing maternal mortality in Nigeria: an approach through policy research and capacity building). Afri J Reprod Health. 2010;14:31-6.
Ochako R, Fotso JC, Ikamari L, Khasakhala A. Utilization of maternal health services among young women in Kenya: Insights from the Kenya Demographic and Health Survey. BMC Pregnancy Child Birth. 2011;11:1.
USAID. Ending Preventable Maternity Mortality. USAID Maternal Health Vision for Action, report, 2014.
Philibert A, Ridde V, Bado A, Fournier P. No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study. Biomed Central J Health Services Res. 2014;14(120).
Kana MA, Doctor HV, Peleteiro B, Lunet N, Barros H. Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014. BMC, Public Health. 2015;15:334.
Kenya Demographic Health Survey, Nairobi, Kenya. 2014.
Kenya National Bureau of Statistics (KNBS) and ICF Macro. In: Maternal Health. Calverton, Maryland, 2012.
Ministry of Health, RMNCAH, Kenya. Investment Framework. Nairobi, Kenya, 2016.
Lantum M. The micro clinic model for rural health care management. The Nyanza pilot 9-months after. Kenya: OGRA Foundation, 2012.
GOK/CBS, Kenya population census. Ministry of Planning and Development. Nairobi, Kenya. 2008/2009.
Witter S, Adjei S, Klemesu MA, Graham W. Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana. Global Health Action. 2009;2:10.
