An Assessment of the implementation of the Free Maternal Services in Murang’a County Referral Hospital
This study aimed to establish the trends of utilization of FMS services at Murang’a County Referral Hospital between 2013 and 2017, to assess the readiness of the hospital to offer FMS and to explore the contextual factors affecting the implementation of FMS. The study adopted a mixed method design. Quantitative data on trends of the use of FMS was obtained from the hospital records. A checklist was used to assess the services availability and readiness, while a qualitative inquiry was done using semi-structured one-on-one interviews with key staff involved in the provision of maternal care at the health facilities. Quantitative data was analysed using SPSS while the qualitative data was analysed using a thematic framework analysis. There was demonstrated initial increase in utilization of skilled care in 2013 after elimination of user fees followed by decreased utilization in 2016 and 2017 which was attributed to unavailability of the services especially during the periods of industrial unrest by health workers and quality concerns. The outcomes however did not show significant improvement. The main challenges identified were inadequate and de-motivated health care workers, shortages of inputs like drugs and other health commodities, lack of continuous quality improvements structures, overcrowding due to inadequate physical facilities and uncompensated loss of revenue. The study recommends development of a robust and well-funded HR system at the county and facility levels. This will address recruitment, motivation, training and retention of health workers; Ring fencing health funds at the county level to ensure uninterrupted service provision; Upgrading of the physical infrastructure, especially the decongestion of the post-natal ward and establishment of an ICU; Strengthening the hospital and county Human Resource (HR) department; and Motivation of the healthcare workers through enhanced remuneration, provision of training and improved working conditions.