Analysis of the effectiveness of free maternity health policy on utilization and financing of health facilities in Mombasa County
Shikely, Khadija Sood Mohamed
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Maternal mortality has been a concern for Kenya for a long time, and one of the reasons for poor uptake of maternal services is the financial barrier. The government was of the view that removing this barrier would dramatically improve uptake. The Government of Kenya decided to have free maternity health care services in order to reduce maternal deaths and to improve on the quality of delivery among pregnant women. Maternal mortality ratio in Mombasa County is 129 per 100.000 live births. Free maternity health policy was born on 1st June 2013, H.E Uhuru Kenyatta, President of the Republic of Kenya declared all women to deliver free in all public hospitals. The main aim of this study was to assess the effectiveness of Free Maternity Health Policy on utilization and financing at health facilities in Mombasa County with the following specific objectives: i) To describe the utilization rate before and after Free Maternity Health Policy. ii) To assess if the Free Maternity Health Policy (financing mechanism) contributed to improved utilization and iii) To assess financial implementation challenges, adequacy of financing the policy and the hospital coping mechanisms. This study employed a descriptive cross-sectional design where the respondents were asked to complete questionnaires, in depth interviews were carried out and in addition, existing health records of mothers who benefitted from the policy and the existing financial records at the facilities during the period of the study, were reviewed to assess the health care utilization and health care financing and its challenges. The study was conducted in Mombasa County at purposively selected sites. The target sites was two high volume health facilities, Likoni and Tudor sub county hospitals, both level four hospitals of similar scope of services and in two different sub counties. The target population included health service administrators, clinicians and nurses providing maternity services in their health care facilities. Data was collected through document reviews, key informant in depth interviews, and extraction from health facilities records. The data collected was coded, quantified and analyzed quantitatively and qualitatively. Quantitative data was analyzed with the use of Statistical Package for Social Sciences (SPSS, version 21.0). The information was displayed by use of bar charts, graphs and pie charts. This was done by tallying up responses, computing percentages of variations in response as well as describing and interpreting the data in line with the study objectives and assumptions through use of SPSS. Thematic analysis was used to test data that is qualitative nature or aspect of the data collected from the open ended questions. The study also conducted a correlation inferential analysis. The results of the study on the utilization levels of maternity services before and after FMHP indicated that there was a significant increase (207 deliveries or 95%) in the number of maternity patients in the health care facilities after FMHP. The greatest increase was seen among mothers aged <35 years (201 deliveries or 102%) - the average age of the delivering mothers being 25 years. The study also shows that the common parity for both before and after FMHP is the 2nd parity at 96 mothers and 177 mothers delivering in may 2012 and may 2014 respectively. The study also found that majority of the patients who delivered at the health facilities had no education and were unemployed. The results also indicates that there was increase in delivery levels by mothers across different levels of education with the highest rate of increase being for mothers with no education at 44 (400%) followed by those with tertiary education at 15 (107%) increase respectively. It is evident from the results that financing mechanisms after FMHP are much better compared to the one before FMHP. This is supported by a significant increase in the revenue, (through reimbursements from the national government) of the health facilities by Ksh 1,703,320 which is four times more (409%) than the revenue collected before FMHP. This can also be explained by the difference in the average fees per delivery charged before FMHP which was Ksh 2082.64 with what the government reimbursed per delivery after FMHP which was Ksh 5000. Majority (80%) of the respondents were of the view that FMHP is achieving its stated purpose and that the health workers (93%) are also complying with the the policy guidelines despite the barriers to compliance particularly at an operational level. Majority of the respondents (87%) affirmed that health workers were not involved in the drafting and implementation of the FMHP. Only 13% of the interviewees were of the view that the health workers were involved. However it is evident that majority (87%) of the respondents believe that the policy has had a greater impact on the quality of health care compared to its impact on financing of maternity health care whereby only 47% of them believed it had a positive impact.