Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage

Abstract

Background The strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial hardship. Linda Mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children. Purpose The aim of this study was to find out the extent of awareness, and involvement among managers, service providers and consumers of Linda mama supported services and benefits of the initiative from the perspectives of consumers, providers and managers. Methods We carried out cross sectional study in four sub counties in western Kenya: Rachuonyo East, Nyando, Nyakach, and Alego Usonga. We used qualitative techniques to collect data from purposively selected Linda Mama project implementors, managers, service providers and service consumers. We used key informant interview guides to collect data from a total of thirty six managers, nine from each Sub -County and focus group discussion tools to collect data from sixteen groups of service consumers attending either antenatal or post-natal clinics, four from each sub county, selecting two groups from antenatal and two from postnatal clinics in each sub county. Data analysis was based on thematic content analysis. Findings Managers and service providers were well aware of the initiative and were involved in it. Participation in Linda Mama, either in providing or using, seemed to be more prominent among managers and service providers. Routine household visits by community health volunteers to sensitize mothers and community engagement was core to the initiative. The managers and providers of services displayed profound awareness of how requiring identification cards and telephone numbers had the potential to undermine equity by excluding those in greater need of care such as under-age pregnant adolescents. Maternity and mother child health services improved as a result of the funds received by health facilities. Linda Mama reimbursements helped to purchase drug and reduced workload in the facility by hiring extra hands. Conclusion The initiative seems to have influenced attitudes on health facility delivery through: Partnership among key stakeholders and highlighting the need for enhanced partnership with the communities. It enhanced the capacity of health facilities to deliver high quality comprehensive, essential care package and easing economic burden.

Four antenatal care visits by four months of pregnancy and four vital tests for pregnant mothers: impact of a community-facility health systems strengthening intervention in Migori County, Kenya

“…This suggests sustained patient-centred QI efforts are needed to address health inequalities and improve ANC attendance. While Kenya’s Linda Mama initiative offers free maternal and child health services, coverage is incomplete, and it does not cover transportation costs [ 55 ]. Decentralising ANC by training community health workers to provide low-risk antenatal care at the community level, such as distribution of IFAS and IPTp, and pregnancy testing, could reduce the distance barriers [ 41 ].…”

Women's preferences for HIV prevention service delivery in pharmacies during pregnancy in Western Kenya: a discrete choice experiment

“…Several factors might have contributed to women's preference for clinics over pharmacies, including the perceived availability of well-trained providers, low-cost comprehensive services, as well as ongoing efforts by the Ministry of Health to encourage antenatal care clinic utilization [29][30][31][32]. Promoting pharmacy use for HIV prevention among pregnant women is a new concept supported by recent studies on pharmacydelivered PrEP and private-sector engagement in primary care [3,26].…”

Exploring the Adaptations of the Free Maternity Policy Implementation by Health Workers and County Officials in Kenya

“…Additionally, facilities are incurring debt to hire additional HCWs. The mismatch between service demand and available resources to provide services has been documented elsewhere 53 but should be aligned through timely disbursement of funds if the country is to meet the universal health coverage goals. Also, by prioritizing the utility of reimbursements from the Linda Mama policy to improve maternity areas and develop strategic collaboration between different hospitals and departments, implementers may focus on attracting more clients.…”