Top

Reproductive Health

Published in:

Open Access 01-12-2015 | Research

Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study

Authors: Evaline Lang’at, Lillian Mwanri

Published in: Reproductive Health | Issue 1/2015

Abstract

Background

Globally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013.

Methods

A qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis.

Results

Free maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy.

Conclusion

Free maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.

World Health Organisation. Trends in maternal mortality 1990 to 2010, UNICEF, UNFPA and The World Banks Estimates. 2012. Available at: http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html. [Accessed 01 February 2013].

World Health Organisation Regional Office for Africa. Addressing the challenges of women’s health in Africa: reports of the commission of women’s health in the African Region. 2012. Available at: http://www.afro.who.int/en/clusters-a-programmes/frh/gender-womens-health-a-ageing/highlights/3741-addressing-the-challenge-of-womens-health-in-africa.html. [Accessed 08 March 2013].

World Health Organisation. Trends in Maternal Mortality: 1990 to 2013 Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: World Health Organisation Library; 2012. Available: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf [Accessed 12 June 2014].

Republic of Kenya. Minister for Health's press statement on the introduction of user charges in government health hospitals and health centers. Nairobi, Kenya: Ministry of Health; 1989.

Mbugua JK, Bloom GH, Segall MM. Impact of user charges on vulnerable groups: the case of Kibwezi in rural Kenya. Soc Sci Med. 1995;41:829–35.CrossRefPubMed

Witter S, Dieng T, Mbengue D, Moreira I, De Brouwere V. The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health Policy Plan. 2010;25:384–92.CrossRefPubMed

Wilkinson D, Gouws E, Sach M, Karim SS. Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa. Bull World Health Organ. 2001;79:665–71.PubMedPubMedCentral

Ministry of Health. National roadmap for accelerating the attainment of MDGs related to maternal and newborn health in Kenya. Nairobi: Reproductive Health; 2010.

Kenya Demographic Health Survey 2003 http://pdf.usaid.gov/pdf_docs/Pnacy934.pdf. [Accessed 22 February 2014].

10.

Central Bureau of Statistics, Ministry of Health Kenya, ORC Macro. Kenya Demographic and Health Survey 2003. 2004. Available at: http://dhsprogram.com/pubs/pdf/FR151/FR151.pdf [Accessed 22 February 2014].

11.

World Health Organization, ICM & FIGO. World Health Organization. Making pregnancy safer: the critical role of the skilled attendant. 2004. Available at: http://whqlibdoc.who.int/publications/2004/9241591692.pdf [Accessed22 June 2014].

12.

Kenya National Bureau of Statistics & ICF MACRO. 2009 Population And Housing Census Results. 2010. Available at: https://drc.dk/about-drc/publications/reports/?eID=dam_frontend_push&docID=6577 [Accessed 22 February 2014].

13.

Municipal Council of Malindi. Municipal council of Malindi strategic plan 2010–2014. Malindi: Municipal Council of Malindi; 2010.

14.

Kenya Health Information; 2012. Available at: https://hiskenya.org/dhis-web-dashboard-integration/index.action. [Accessed 06 January 2014].

15.

Kenya National Bureau of Statistics & ICF MACRO. Kenya Demographic Health Survey 2008/2009. 2009. Available at: http://dhsprogram.com/pubs/pdf/FR229/FR229.pdf [Accessed 22 February 2014].

16.

Pawson R, Tilley N: Realistic Evaluation. In. Edited by Pawson R, Tilley N. United Kingdom: British Cabinet Office; 2004

17.

Ogrinc GPB. Realist evaluation as a framework for the assessment of teaching about the improvement of care. Nursing Educ. 2009;48(12):661–8.CrossRef

18.

Liamputtong P. Research methods in health; foundation for evidence based practice. 2nd ed. Oxford: South Melbourne; 2013.

19.

Braun V, Clarke V: Successful Qualitative Research: A Practical Guide for Beginners. Sage Publications 2013.

20.

Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. JOAAG 2009;4(2):72–9.

21.

Ritchie S. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analyzing Qualitative Data. London: Routledge; 1994. p. 173–94.CrossRef

22.

Moretti F, Bensing J, Deledda G, Mazzi M, Rimondini M, Zimmermann C, et al. A standardized approach to qualitative content analysis of focus group discussions from different countries. Patient Educ Couns. 2011;82(3):420–8.CrossRefPubMed

23.

Chatburn RL. Handbook for health care research. 2nd ed. Jones and Bartleh: United Kingdom; 2011.

24.

Russell B, Purcell J. Online research essentials: designing and implementing research studies. 1st ed. San Francisco: John Wiley & Sons; 2009.

25.

Hatt LE, Makinen M, Madhavan S, Conlon CM. Effects of user Fee exemptions on the provision and Use of maternal health services: a review of literature. Health Population Nutrition J. 2013;31:4.

26.

Witter S, Khadka S, Nath H, Tiwari S. The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan. 2011;26(2):84–9.

27.

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). Africa J Reproductive Health. 2010;14:31–6.

28.

El-Khoury M, Hatt L, Gandaho T. User fee exemptions and equity in access to caesarean sections: an analysis of patient survey data in Mali. Int J Equity Health. 2012;11:49.CrossRefPubMedPubMedCentral

29.

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 Plan. 2011;26(2):92–103.

30.

Mwabu G, Mwanzia J, Liambila W. User charges in government health facilities in Kenya: effect on attendance and revenue. Health Policy Plan. 1995;10(2):164–70.CrossRefPubMed

31.

Penfold S, Harrison E, Bell J, Fitzmaurice A. Evaluation of the delivery fee exemption policy in Ghana: population estimates of changes in delivery service utilization in two regions. Ghana Med J. 2007;41:100–9.PubMedPubMedCentral

32.

Witter S, Arhinful DK, Kusi A, Zakariah-Akoto S. The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Reproductive Health Matters. 2007;15:61–71.CrossRefPubMed

33.

Nimpagaritse M, Bertone MP. The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy Plan. 2011;26(2):ii63–71.PubMed

34.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRefPubMed

35.

Mwamuye MK, Nyamu HM. Devolution of health care system in Kenya: a strategic approach and its implementation in Mombasa county. Kenya Int J Advanced Res. 2014;2(4):263–8.

36.

Gilson L, Doherty J, Loewenson R, Francis V. Challenging Inequity Through Health Systems. In: Final Report: Knowledge Network on Health Systems. 2007.

37.

Nzinga J, Mbaabu L, English M. Service delivery in Kenyan district hospitals - what can we learn from literature on mid-level managers? Hum Resour Health. 2013;11(1):10.CrossRefPubMedPubMedCentral

38.

Mwanri L, Hiruy K, Masika J. Empowerment as a tool for a healthy resettlement: a case of new African settlers in South Australia. Int J Migration Health and Social Care. 2012;8(2):86–97.CrossRef

39.

Alma Ata Declaration. International Conference on Primary Health Care, Meeting in Alma-Ata, USSR, 6–12 September. 1978. Available at: http://www.who.int/publications/almaata_declaration_en.pdf. [Accessed 10 June 2013].

40.

Ndep AO. Informed community participation is essential to reducing maternal mortality in Nigeria. Int J Health and Psychol Res. 2014;2(1):26–33.

41.

Levers LL, Magweva FI, Mpofu E. A literature review of district health systems in east and southern Africa: facilitators and barriers to participation in health. 2007. Available at: http://www.equinetafrica.org/bibl/docs/DIS40ehsLOPEZ.pdf. [Accessed 22April 2014].

Title: Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study
Authors: Evaline Lang’at
Lillian Mwanri
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Reproductive Health / Issue 1/2015
Electronic ISSN: 1742-4755
DOI: https://doi.org/10.1186/s12978-015-0048-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

The success factors of scaling-up Estonian sexual and reproductive health youth clinic network - from a grassroots initiative to a national programme 1991–2013

Ante natal care (ANC) utilization, dietary practices and nutritional outcomes in pregnant and recently delivered women in urban slums of Delhi, India: an exploratory cross-sectional study

Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey

Official invitation letters to promote male partner attendance and couple voluntary HIV counselling and testing in antenatal care: an implementation study in Mbeya Region, Tanzania

Exposure to family planning messages and modern contraceptive use among men in urban Kenya, Nigeria, and Senegal: a cross-sectional study

Factors associated with crisis pregnancies in Ireland: findings from three nationally representative sexual health surveys