Does Access to Health Care Guarantee Quality of Care An Enquiry into the Trend of Facility Deliveries and Maternal Mortality Following the Implementation of Free Maternity Care in Kenya

摘要

Background: The reduction and elimination of maternal mortality remain a challenge in most low income countries. Kenya joined other African countries in the abolishment of delivery fees in all public health facilities through a presidential directive signed into effect on June 1, 2013. Unfortunately, this does not guarantee its use and optimal outcomes. This study aimed to demonstrate the trends in facility-based deliveries and maternal mortalities in Kenya from the year 2012 to 2019, and programmatic efforts for increasing quality, coverage, and utilization of BEmONC services as well as critical support systems at all referral levels. Setting: Health facilities in the 47 counties in Kenya. Methods: Data was extracted from the Kenya Health Information System (KHIS). Descriptive analysis of 8 years trend (2012-2019) was adopted complemented with univariate and bivariate analysis with figures. Outcome: Overall, evidence on the implementation of the free maternity policy showed increased utilization of health facilities but did not have a significant effect on maternal mortality. The facility deliveries and maternal mortality across the 8 years followed the same trend, and the difference across years statistically remained the same. Increased mortality with increased utilization points to a crucial gap in quality of care. Conclusions: Increasing facility birth does not translate into reduced mortality unless quality of care is assured. There is need to strengthen the capacity of the supply side through sustainable financing, strengthen institutional capacity for delivery of quality RMNCAH services, build strong leadership and a coherent institutional response, leverage changes in public policy and build a knowledge base and monitoring progress.