BackgroundKenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy’s effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities.MethodsA time series analysis was conducted on health facility delivery services utilization, maternal and neonatal mortality 2 years before and after the policy intervention in 77 health facilities across 14 counties in Kenya.ResultsA statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the ratio of maternal mortality and the rate of neonatal mortality.ConclusionThe findings suggest that cost is a deterrent to health facility delivery service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1708-2) contains supplementary material, which is available to authorized users.

Background Patients' satisfaction is an individual's positive assessment regarding a distinct dimension of healthcare and the perception about the quality of services offered in that health facility. Patients who are not satisfied with healthcare services in a certain health facility will bypass the facility and are unlikely to seek treatment in that facility. Objective To determine satisfaction level of mothers with the free maternal services in selected Kenyan public health facilities after the implementation of the free maternal healthcare policy. Methods Data was collected through a quantitative exit survey questionnaire. The respondents were mothers who had delivered in the health facilities and were waiting to leave the health facilities after discharge. The sample included 2,216 mothers in 77 public health facilities across 14 counties in Kenya under tier 3 and tier 4 categories. The number of respondents to be interviewed was proportionately arrived at based on each health facility's bed capacity. Results The study established a satisfaction rate of 54.5% among the beneficiaries of the free maternal healthcare services in the country. Mothers benefiting from the free delivery services were satisfied with communication by the healthcare workers, staff availability in the delivery rooms, availability of staff in the wards, and drug and supplies availability (>56%) but unsatisfied with consultation time, cleanliness, and privacy in the wards (<56%). High education levels and lengthy stay in healthcare facilities were negatively associated with the satisfaction with the free delivery services (P < 0.05). Conclusion There is a high satisfaction with the free maternal healthcare services in Kenya. However, the implementation of the free maternal healthcare policy was associated with low privacy, poor hygiene, and low consultation time in the health facilities. Therefore there is need to address these service gaps so as to attract more mothers to deliver in public health facilities.

Background: Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting skilled delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of the free maternal health care policy’s effect on skilled delivery service utilization and maternal and neonatal mortality rates in Kenyan public health facilities. Methods: Interrupted time series analysis of skilled delivery services utilization, maternal and neonatal mortality rates two years before and after the policy intervention was carried out in 77 Kenyan public health facilities. Results: A statistically significant increase in the number of facility-based deliveries was identified with no significant changes in the rates of maternal mortality and neonatal mortality. Conclusions: The findings suggest that cost is a deterrent to skilled delivery service utilization in Kenya and thus free delivery services are an important strategy in the effort to promote the utilization of skilled delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related deaths when addressing maternal and neonatal mortality rates.

test score of 11.6. Data is still being collected for 6, 9, and 12 months post-course completion.Interpretation: As part of an ongoing initiative, a novel layprovider trauma course was developed and implemented in rural Peru to address disparities of pre-hospital care in LMIC. Initial data indicates course efficacy with adequate knowledge and skill retention. Future project goals include completing longitudinal course evaluation, expanding training capacity, transitioning to incountry leadership, and collecting end-point data regarding patient outcomes in the Cusco region of Peru. Source of Funding: None.Abstract #: 1.048_HHRAbstract #: 1.052_HHR Health Systems and Human ResourcesA n n a l s o f G l o b a l H e a l t h , V O L . 8 3 , N O . 1 , 2 0 1 7 J a n u a r y eF e b r u a r y 2 0 1 7 : 1 8 -5 8