The Uptake And Utilization Of Free Maternal Health Care Services In Kericho County, Kenya

Abstract

Utilization of maternal health services is expected to improve maternal and neonatal health outcomes. Understanding the factors affecting maternal health use is crucial. Financial constraints are one of the major factors contributing to lack of access to quality maternal healthcare services for mothers in Kenya. The Government of Kenya introduced Free Maternal Care services policy in all public health facilities. The policy was formulated to ease financial barriers associated with equitable access to skilled maternal health care services. Objectives The main objective of the study was to evaluate the impact of the introduction of free maternal care policy in Kericho County’s obstetric indicators and challenges in the implementation of the policy. Method The study was divided into two parts. The first part was the qualitative cross sectional study that involved key informant interviews. The study population was key county officials involved in the implementation of the policy at the county level. A ground theory approach was used to conduct data analysis of the transcribed interviews. The second part was a longitudinal ecological study in which quarterly returns of service utilization indicators were obtained from the Kericho County Health Management Information System database from 2011 to the first quarter of 2015. The data was subjected to segmented regression analysis by generalized least square regression. The data was also decomposed to trend and seasonal components. Data was analyzed using R version 3.2.2 statistical program. The level of significance was set at 0.1 Results The free maternal health care policy implemented in June 2013 has had mixed effects on health care service delivery indicators. With regard to Antenatal care attendance, there was a significant quarter to quarter drop in Antenatal care attendance at the rate of -304.61 visits per xiii quarter(p<0.002). There was a significant increase in maternal deliveries at a rate of 894.074 deliveries per quarter (p<0.001). There was an insignificant decrease in the use of oxytocin at a rate of 2596.4 ampoules per quarter (p<0.513). Maternal mortality ratio decreased insignificantly at the rate of 4.992 deaths per 10,000 live births (p=0.102). In the qualitative study, it was realized that there was increased workload at the facilities while the staffing levels remained the same. This has led to declined quality of services and overstretching of resources such availability of medical supplies, equipment and infrastructure. Some services such as ante natal care profile, ultra sound were not free as expected in the policy. Conclusion The study found out that there was an increased utilization of maternal delivery services as well as use of drugs and medical supplies. The maternal mortality ratio also declined significantly since 2011. However, there was need to improve on the quality of services in order to avoid mothers from turning away from the services