Can incentives reduce the barriers to use of antenatal care and delivery services in Kenya?: Results of a qualitative inquiry

Abstract

A qualitative inquiry was used to assess if incentives consisting of a hygiene kit, protein-fortified flour, and delivery kit reduced barriers to antenatal care and delivery services in Nyanza Province, Kenya. We conducted 40 interviews (baseline: five nurses, six mothers, one focus group of five mothers; follow-up: nine nurses, 19 mothers) to assess perceptions of these services. Mothers and nurses identified poor quality of care, fear of HIV diagnosis and stigma, inadequate transport, and cost of care as barriers. Nurses believed incentives encouraged women to use services; mothers described wanting good birth outcomes as their motivation. While barriers to care did not change during the study, incentives may have increased service use. These findings suggest that structural improvements—upgraded infrastructure, adequate staffing, improved treatment of women by nurses, low or no-cost services, and provision of transport—could increase satisfaction with and use of services, improving maternal and infant health.

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use

“…Both explanations were noted by women who participated in this study, and participants in the qualitative evaluation associated with this project. 18 We were unable to determine whether a relationship exists between wealth tertiles and service use. In no case was maternal health service use significantly higher between the wealthiest and poorest tertiles, suggesting that relative wealth of mothers was not an important factor, or that our methods did not accurately capture socioeconomic status.…”

“…These results were consistent with qualitative research findings obtained during this project. 18 In western Kenya at the time of this evaluation, pregnant women in labor were required to purchase surgical gloves and give them to the health-care provider to be admitted to the health facility. The provision of surgical gloves, sterile razor blades, and cord ties therefore lowered barriers to care while helping ensure better quality of care, whereas swaddling cloth and water storage containers in the delivery kits provided valued commodities as incentives for mothers to deliver in a health facility.…”

“…Quantitative and qualitative data collected in this evaluation were also consistent with findings in other studies where incentives such as hygiene kits, insecticide-treated bed nets, and cash payments increased the use of antenatal services. [18][19][20][21][22][23] Second, other organizations might have provided different incentives which may have influenced mothers to seek care. Multiple queries over the course of the intervention yielded no evidence of additional incentives being offered at these clinics, or of any decrease in the cost of care for ANC services that could have explained the increase in care-seeking behavior.…”

“…25 Improved quality of care has been shown to increase services use in other studies; however, we found no evidence in our quantitative or qualitative evaluations to support this hypothesis. 18,26,27 Finally, increased training, frequent health facility visits, and scrutiny of services performed by our implementation and evaluation teams may have motivated nurses to provide more humane care to pregnant women, which in turn, could have elicited increased service use. Poor treatment of obstetric patients, which has been documented in the literature and verified in the news media in Kenya, has been a barrier to care for many women.…”

Are Free Maternity Services in Kenya really free?

“…Although maternal and child health continues to be one of the strategic priorities in Kenya's health sector, before free maternity services got introduced in 2013 in fulfillment of Kenya's new constitutional demand for universal access to health care, only 44% of mothers in Kenya were able to access skilled birth attendance (SBA) [4,5,6]. The cost of receiving antenatal and delivery services has been observed as one of the barriers that hinder mothers using skilled services in Kenya's public health facilities [7,8].…”