Introduction: Kenya
implemented the policy of free maternity services to reduce maternal mortality and
morbidity. For successful implementation of this policy, there is need to monitor
the implementation progress, identify the challenges and mitigate them and determine
better strategies for implementation based on emerging implementation issues. This
study was carried out to determine the challenges facing policy implementation and
strategies for better implementation.
Methods: this
was a cross-sectional descriptive study carried at the Rift Valley Provincial General
Hospital (RVPGH) and Bondeni maternity. All the staff who work at Bondeni Maternity
(including nursing officer in-charge) were included in the study. All the staff
who work at the Maternity Unit of the RVPGH were included in the study, as well
as the Medical Superintendent of the facility. A total of 110 respondents were sampled.
A questionnaire and interview guide were used to collect data. Data was analyzed
using SPSS software.
Results: a
response rate of 91% (n=100) was achieved. Major implementation challenges include
inadequate supplies (86%), inadequate funding (38%), staff shortage (92%), lack
of motivation among health workers (62%), overwhelming workload (89%) and abuse
of services by clients (32%). Strategies for better implementation include employment
of more staff, motivation of health workers, improvement in policy financing, training
of health workers and provision of adequate supplies.
Conclusion: implementation
of free maternity services policy in Kenya is facing challenges but there exists
strategies, which, if implemented, will help address these challenges.
Table 2: comparison of implementation challenges between the two facilities
| ||||
Facility
|
P-values
| |||
NakuruPGH (%)
|
Bondeni Maternity (%)
| |||
Financial challenges
|
Yes
|
29 (33.7)
|
9 (64.3)
|
0.029
|
No
|
57 (66.3)
|
5 (35.7)
| ||
Supplies challenges
|
Yes
|
72 (83.7)
|
14 (100)
|
0.208
|
No
|
14 (16.3)
|
0 (0.0)
| ||
Health workers inadequate skills
|
Yes
|
14 (16.3)
|
3 (21.4)
|
0.702
|
No
|
72 (83.7)
|
11 (78.6)
| ||
Staff shortage challenges
|
Yes
|
78 (90.7)
|
14 (100)
|
0.596
|
No
|
8 (9.3)
|
0 (0.0)
| ||
Overwhelming work
|
Yes
|
77 (89.5)
|
12 (85.7)
|
0.65
|
No
|
9 (10.5)
|
2 (14.3)
| ||
Rude client
|
Yes
|
24 (27.9)
|
2 (14.3)
|
0.346
|
No
|
62 (72.1)
|
12 (85.7)
| ||
Abuse of free services
|
Yes
|
24 (27.9)
|
8 (57.1)
|
0.03
|
No
|
62 (72.1)
|
6 (42.9)
| ||
Lack of managerial support
|
Yes
|
9 (10.5)
|
9 (64.3)
|
0.001
|
No
|
77 (89.5)
|
5 (35.7)
|
Full article at: http://goo.gl/ZOPwGS
By: Emmanuel Wekesa Wamalwa1,&
1Department of Health Systems Management, Kenya
Methodist University
More at: https://twitter.com/hiv insight
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