How do We Better Target Kenya’s Poorest Women With Subsidized Maternity Care?

July 17, 2017

About 21 pregnant women die everyday in Kenya due to complications from childbirth. That’s equivalent to two 10-seater matatus crashing every day, killing all the passengers on board. Pregnant women in Kenya–as in other countries in the developing world–die because they either do not receive appropriate care during pregnancy or are unable to deliver their babies with health professionals in attendance.

It is money, not lack of knowledge, that prevents women from seeking skilled care during labor and delivery. According to the 2013 Kenya Household Health Expenditure and Utilization Survey, women spent on average Ksh. 22,280 (US$223) on four antenatal visits in government facilities. The out-of-pocket cost for a normal delivery was approximately Ksh. 5,443 (US$55). The costs associated with a normal pregnancy and delivery would constitute more than 20% of the gross national income of US$1,380 per capita, which poses  a huge financial burden.

To address this problem and lower Kenya’s maternal mortality rate, the Ministry of Health introduced a Free Maternity Services (FMS) program in July 2013, aiming to immediately remove user fees for maternity care in public health facilities nationwide. The free maternity care initiative is a cornerstone of a wider strategy to ensure equity in maternal health and achieve the ultimate goal of Universal Health Coverage (UHC), which would ensure that all Kenyans have a access to quality, affordable health care services without suffering financial hardship.

FMS generated about Ksh. 5 billion (approx US$50 million) in direct reimbursements from the government to health facilities between 2013 and 2016. As of early 2018, the program will be administered through the  National Hospital Insurance Fund (NHIF); piloting began in June 2017 in selected low-cost private and faith-based health facilities under the Linda Mama initiative. A total of 30,000 pregnant women registered under Linda Mama by end of June 2017 are expected to benefit from free maternal and newborn care services for up to one year.

However, questions remain on the ability of NHIF to ensure the needs of the poorest women who most need access to free or subsidized care are met.

“Inequalities in access to skilled delivery have reduced under the free maternity services program, but the rich-poor gap is far from being closed,” says Dr. Estelle Sidze, a maternal and child health expert. “There is need for a more targeted outreach to the poorest women beyond a simple fee waiver at facility level.”

Remaining gaps to accessing to maternal health services were highlighted in a recent study by The African Population and Health Research Center (APHRC) in collaboration with the Amsterdam Institute for Global Health and Development (AIGHD), The Palladium Group and PharmAccess Foundation. The study assessed the  impact of the free maternity care  in terms of targeting of the poor, quality of care, utilization and out-of-pocket expenditure.

The study illustrated the links between the maternity fee waiver and inclusive growth. Saving women’s lives means preserving productive years of women’s potential employment and potential family income. Maternal income improves children’s chances of obtaining an education without the threat of leaving school early to work to replace lost maternal income.

The project team shared the findings with key stakeholders in the maternal health sector on June 22 in Nairobi to brainstorm ways to improve program implementation to achieve equity in access to maternal health services. The recommendations by the project team include:

  • Rolling out intensive awareness campaigns to ensure that more pregnant women register for NHIF to access free services, keeping in mind the Ministry of Health target of reaching 400,000 pregnant women delivering at home in the next year, with a particular focus on the most vulnerable women in urban low-income settings and rural hard-to-reach areas.
  • Adopting a strong monitoring and evaluation system as part of the national strategic plan. This will help in assessing improvements in aggregate coverage of services, and uncover and target inequalities so that the most disadvantaged women have the same access to quality maternity care as the richest women.
  • Ensuring access to free maternity care services is a key pillar of the Social Protection Policy and safeguarding the right for poor women who are not able to contribute to NHIF to access the package of essential services including maternity care as stipulated by the policy.

A four-minute video Healthy Mothers, Healthy Babies shows the experience of free maternity care through the eyes of an expectant mother and a healthcare provider.