COVID-19 Effect on Access to Maternal Health Services in Kenya

Abstract

Introduction: Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements.Methods: Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of COVID-19, their perceived risk of infection, access to health facilities, perceived quality of care were assessed. Challenges that women facing as a result of the lockdown and curfew with respect to maternal health access and quality were also assessed.Results: Our findings illustrate that there was a high awareness of the symptoms and preventative measures for COVID-19 amongst women in informal settlements. Our findings also show that women's perception of risk to themselves was high, whereas risk to family and friends, and in their neighborhood was perceived as low. Less than half of women reported reduced access due to fear of contracting Coronavirus, Deprioritization of health services, economic constraints, and psychosocial effects were reported due to the imposed lockdown and curfew. Most respondents perceived improvements in quality of care due to short-waiting times, hygiene measures, and responsive health personnel. However, this was only reported for the outpatient services and not in-patient services.Conclusion: The most important recommendation was for the Government to provide food followed by financial support and other basic amenities. This has implications for the Government's mitigation measures that are focused on public health measures and lack social safety-net approaches for the most vulnerable communities.

The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal

“…Just prior to the COVID-19 pandemic, Roder-DeWan and colleagues called for a health system redesign of MNH services in low and middle-income countries, strengthening primary level referral facilities to provide comprehensive services, reducing overcrowding in high-level referral facilities, and providing the care needed to women closer to home [ 44 ]. The COVID-19 pandemic may actually provide an opportunity for health systems to reimagine their systems to do this as evidence from our study and others have shown reduction in institutional deliveries at higher-level facilities overall [ 5 , 7 ]. However, the change in the pattern of utilization of primary and secondary referral hospitals during the pandemic demonstrated in this study provides new information on the opportunity for future redesign and strengthening of services [ 33 ].…”

Malaria incidence and mortality in Zimbabwe during the COVID-19 pandemic: analysis of routine surveillance data

“…While these mitigation measures were aimed at slowing down the spread of COVID-19 and preventing healthcare systems from becoming overwhelmed, there have been wide-reaching unintended consequences on health systems. The demand for essential health services has been adversely affected by stay-at-home orders, stigma and fear of contracting COVID-19 infection, travel restrictions, increased financial barriers and misinformation about COVID-19 [5][6][7]. The provision of routine health services has been disrupted by the diversion of limited resources and health care workers for COVID-19 prevention and control efforts, the occupational risk faced by health care workers, the lack of personal protective equipment, and breakdowns in procurement and supply chains for medicines and commodities [7,8].…”

“…The demand for essential health services has been adversely affected by stay-at-home orders, stigma and fear of contracting COVID-19 infection, travel restrictions, increased financial barriers and misinformation about COVID-19 [ 5 – 7 ]. The provision of routine health services has been disrupted by the diversion of limited resources and health care workers for COVID-19 prevention and control efforts, the occupational risk faced by health care workers, the lack of personal protective equipment, and breakdowns in procurement and supply chains for medicines and commodities [ 7 , 8 ]. Similar reductions in the demand and provision of essential health services were observed during the 2014–2016 Ebola outbreak in West Africa [ 9 ].…”

Challenges in Maternal and Child Health Services Delivery and Access during Pandemics or Public Health Disasters in Low-and Middle-Income Countries: A Systematic Review

“…Many studies suggested the need for satellite clinics to continue antenatal services during disasters. Many studies noticed unbalanced dietary patterns both in pandemics and disasters [ 16 , 17 , 18 , 19 , 20 , 27 , 35 ].…”

“…Another reason for increased home delivery during disease outbreaks was the risk perception of getting the healthcare staff’s infection [ 17 , 24 , 27 , 33 , 35 ]. Community members were afraid to seek treatment from healthcare facilities.…”