Effects of free maternity program on utilization of maternity services and challenges at Kakamega County Hospital, Kenya

Abstract

Background: Maternal mortality is a serious problem particularly in resource strained countries including Kenya. Many countries have come up with various reproductive health interventions with the aim of reducing the maternal mortality. In Kenya, one such key intervention was the introduction of the Free Maternity care program whose objective was to increase access and improve utilization of maternity services with the aim of reducing maternal mortality. Objective: To assess the effects of Free Maternity Care program (FMC) on utilization of maternity services and challenges of the program implemented by the Kenyan Government in 2013 at Kakamega county Hospital. Specifically, to examine the levels of utilization of maternity care services before and after the implementation of the FMC program, determine level of client satisfaction in the era of the program and identify challenges facing the program. Methods: Hospital based cross-sectional descriptive design involving both quantitative and qualitative methods were employed. Two hundred and twenty three (223) post natal mothers selected systematically were interviewed on client satisfaction and challenges. Challenges facing the program were also sought from health care providers and the administration. Records pre –post program periods were reviewed to compare utilization of services. Questionnaires and interview schedules were the tools of data collection. Independent T-test and chi-square were used in analysis which was done by use of SPSS version 20. P of <0.05 was considered significant. Qualitative data was analyzed in themes. Results: There was a significant difference in mean number of deliveries pre and post free maternity program periods (p=0.001). However, there was no difference in the number of new ANC clients and postnatal attendance (p=0.790 and p=0.449) respectively. Majority of the clients interviewed were satisfied with the services offered. The administrators, the health care providers and the clients all agreed that the program was good though it was facing some challenges which needed to be addressed by the policy makers. Conclusion: Free maternity care program has led to increased utilization of facility deliveries just like in other countries with similar programs. It is a timely and noble idea with acceptance by all stake holders though it is faced with some challenges which need to be addressed by the policy makers. Recommendations: All efforts should be made to sustain the FMC program including the policy makers addressing the challenges raised by the stake holders and taking into consideration the suggestions raised. Monitoring and evaluation of the program is essential to foresee its sustainability