Influence of Service Provision Readiness and Livelihood on Maternal Health Services Utilization Patterns in Kenya
Abstract
This is a study report on the relationship between Maternal Service Provision Readiness and
Maternal Skilled Delivery Services Utilization using Kenya’s county level data. The report
also contains the results of investigation of the relationship between nomadic livelihood and
skilled delivery coverage. The broad objective was to determine if the current Maternal
Services Utilization patterns across Kenya’s counties could be explained by Maternal
Services Provision Readiness and Nomadic livelihoods. The study was anchored on the
theories of Health Seeking Behaviour (Rebhan, 2010) and Resource Based View (Barney,
1991). Service Provision Readiness is a measure of the supply side capacity to provide
quality services (WHO, 2014) while utilization is used as a measure of access. The concept of
Superior Utilization was introduced to benchmark the country’s performance against sub-
Saharan Africa’s MDG achievement (United Nation, 2015) using the knowledge anchored on
RBT. Benchmarking has become a standard management practice. The northern Counties of
Kenya, predominantly nomadic, did not register improved health outcomes generally
(KHSSP II). The study sought to answer the following questions: is there regional disparity in
the production and consumption of maternal health services in Kenya? Is nomadic livelihood
a constraint to access? Does investment in the supply side (readiness to provide maternal
services) explain maternal skilled delivery differentials across counties of Kenya? The study
focused on Readiness, Livelihood and Utilization of maternal skilled delivery services. A
descriptive, cross-sectional design was used. County was the unit of analysis and both
multiple linear regression and binary choice methods were employed in the analysis using
STATA 12 statistical software. Data source on utilization was obtained from Kenya
Demographic Health Survey (2014) while Readiness data was obtained from SARAM report
(Government of Kenya, 2014). These data were linked and analysed according to the study
objectives to answer the above research questions. The following were the findings of the
study: disparities in preparedness exist at all levels of KEPH; disparity was least in health
centre preparedness (CV, 18%) and highest in hospitals (CV, 23%); Health centres readiness
was the only supply side factor which could explain maternal delivery pattern(r= 0.307,
p<0.05); improving health centre maternal service provision readiness increases maternal
skilled delivery coverage. Changing a county from nomadic improves maternal delivery
coverage and increases its predictive probability for better performance. Nomadic livelihood
reduces the likelihood of a county realizing acceptable utilization levels of maternal delivery
services. Achieving Secondary education level for women significantly increases the
likelihood of a county realizing acceptable skilled delivery coverage by 4.9%. Demand-side
factors have the most influence on maternal skilled deliveries compared to the supply-side.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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