Original Research

The differential effect of the free maternity services policy in Kenya

Henry O. Owuor, Stephen A. Asito, Samson O. Adoka
African Journal of Primary Health Care & Family Medicine | Vol 11, No 1 | a1887 | DOI: https://doi.org/10.4102/phcfm.v11i1.1887 | © 2019 Henry O. Owuor, Stephen A. Asito, Samson O. Adoka | This work is licensed under CC Attribution 4.0
Submitted: 16 July 2018 | Published: 27 May 2019

About the author(s)

Henry O. Owuor, Department of Family Medicine, School of Medicine, Moi University, Kesses, Uasin Gishu County, Kenya
Stephen A. Asito, Department of Biological Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
Samson O. Adoka, Department of Public Health, School of Health Sciences, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya


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Abstract

Background: The Government of Kenya introduced the free maternity services (FMS) policy to enable mothers deliver at a health facility and thus improve maternal health indicators.

Aim: The aim of this study was to determine if there was a differential effect of the policy by region (sub-county) and by facility type (hospitals vs. primary healthcare facilities [PHCFs]).

Setting: The study was conducted in Nyamira County in western Kenya.

Methods: This was an interrupted time series study where 42 data sets (24 pre- and 18 post-intervention) were collected for each observation. Monthly data were abstracted from the District Health Information System-2, verified, keyed into and analysed by using IBM-Statistical Package for the Social Sciences (SPSS-17).

Results: The relative effect of the policy on facility deliveries in the county was an increase of 22.5%, significant up to the 12th month (p < 0.05). The effect of the policy on deliveries by region was highest in Nyamira North and Masaba North (p < 0.001 up to the 18th month). The effect was larger (46.5% vs. 18.3%) and lasted longer (18 months vs. 6 months) in the hospitals than in the PHCFs. The increase in hospital deliveries was most significant in Nyamira North (61%; p < 0.001). There was a medium-term effect on hospital deliveries in Borabu (up to 9 months) and an effect that started in the sixth month in Manga. The relative effect of the policy on facility deliveries in PHCFs was only significant in Nyamira North and Masaba North (p < 0.001).

Conclusion: The effect of the FMS policy was varied by region (sub-county) and by facility type.


Keywords

free maternity services policy; deliveries attended by skilled birth attendants; skilled care delivery; facility type; sub-county; Nyamira County; Kenya region

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