Implementation Of Free Maternal Services Among Postnatal Women In Selected Public Hospitals In Nyanza, Kenya

ABSTRACT

Financial-related barriers to accessing conventional maternal health services is a major bottleneck in Low and Middle Income Countries (LMIC) with about 600,000 maternal deaths occurring worldwide. Over 90% of these deaths occur in Africa and Asia. Currently, in Kenya Maternal Mortality Rate (MMR) is 362 deaths per 100,000 live births it is far away from achieving MMR reduction to 147 deaths per 100,000 live births. Nyanza’s MMR is higher than the national average. Approximately 1300 to 2000 deaths per 100,000 live births occur in Nyanza alone. She has the highest, 14.9% maternal deaths in Kenya with lowest, 26% hospital deliveries. Consequently, Kenya introduced Free Maternal Services (FMS) in June 2013 when there were only 44% hospital deliveries. After a short while of implementation, there was a significant rise of 66% deliveries. However, gaps in maternal service delivery still exist due to costs associated with delivery services, poor staffing, increased rates of Traditional Birth Attendants (TBAs), inadequate maternal structures and inaccessibility. There is inadequate information on studies in Kenya that have assessed the ongoing implementation of FMS in Kenya. The aim of the study was to assess the implementation of FMS among postnatal women in public hospitals in Nyanza, Kenya. Specifically, the study established the proportion of postnatal women receiving FMS, relationship of socio-demographic, economic factors with status of FMS implementation, utilization trends of FMS, satisfaction of postnatal women on FMS and health system factors for FMS implementation. This analytical cross-sectional study was conducted in 6 Sub-County hospitals in 3 counties in Nyanza among 1152 postnatal women in public hospitals. Multi-stage sampling and Simple Random Sampling (SRS) was used to select participating counties, Sub-Counties and public hospitals. Postnatal women were sampled proportionately by convenient sampling. Data was collected by use of semi-structured exit-interviews, observational checklist, Key Informant Interview (KII) and Focused Group Discussions (FGDs). Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 23 and qualitative data was analyzed using content analysis according to emerging themes. Data was presented in tables, pie charts and bar graphs. About 45.5% postnatal women paid for “FMS”. They incurred a cost on items like ANC, 26.3%; normal delivery (4.8%); caesarian (3.8%); admission fees (26.7%), diapers (46.1%); sanitary pads (52.8%) and drugs (7.2%) all with a statistically significant relationship of p