Implementation Challenges of Free Maternity Services Policy in Kenya: The Health Workers’ Perspective

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 Wamalwa^1,&

¹Department of Health Systems Management, Kenya Methodist University

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8 Depressing/Uplifting Things We Learned About Women This Year

Via:   http://goo.gl/QuVg5q 

Prevalence & Characteristics of Intended Adolescent Pregnancy: An Analysis of The Canadian Maternity Experiences Survey

Background

There is limited research focusing on adolescent women who intended to become pregnant, as majority of research examines unintended adolescent pregnancies. The objective was to examine the prevalence and characteristics of Canadian adolescent women who intended to become pregnant.

Methods

The analysis was based on the national 2006 Maternity Experiences Survey consisting of women who had a singleton live birth. The sample was restricted to adolescent women between 15 to 19 years of age. The main outcome of this study was the adolescent woman’s pregnancy intention. A variety of sociodemographic, maternal, and pregnancy related factors were examined using a multivariable logistic regression. Adjusted odds ratios (OR) and 95 % confidence intervals (CI) were reported for all variables.

Results

The sample size was 290, weighted to represent 2224 adolescent women. Based on the adjusted model, the odds of experiencing an intended pregnancy were increased if the adolescent woman was between 18–19 years old, had a partner, experienced no violence/abuse, and consumed no alcohol before pregnancy. Additionally, adolescent women who reported drug use prior to pregnancy were more likely to have an intended pregnancy.

Conclusion

The findings from this study can be used as the basis for future research to investigate the characteristics and needs represented by this group of adolescents and to aid in the development of effective policies and programs.

Full article at:  http://goo.gl/YypO8v

By:   Vineeth S. Sekharan, Theresa H. M. Kim^*, Elizaveta Oulman and Hala Tamim

School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto M3J 1P3ON, Canada

 

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Infrastructural Challenges to Better Health in Maternity Facilities in Rural Kenya: Community & Healthworker Perceptions

The efforts and commitments to accelerate progress towards the Millennium Development Goals for maternal and newborn health (MDGs 4 and 5) in low and middle income countries have focused primarily on providing key medical interventions at maternity facilities to save the lives of women at the time of childbirth, as well as their babies. However, in most rural communities in sub-Saharan, access to maternal and newborn care services is still limited and even where services are available they often lack the infrastructural prerequisites to function at the very basic level in providing essential routine health care services, let alone emergency care. Lists of essential interventions for normal and complicated childbirth, do not take into account these prerequisites, thus the needs of most health facilities in rural communities are ignored, although there is enough evidence that maternal and newborn deaths continue to remain unacceptably high in these areas.

This study uses data gathered through qualitative interviews in Kitonyoni and Mwania sub-locations of Makueni County in Eastern Kenya to understand community and provider perceptions of the obstacles faced in providing and accessing maternal and newborn care at health facilities in their localities.

The study finds that the community perceives various challenges, most of which are infrastructural, including lack of electricity, water and poor roads that adversely impact the provision and access to essential life-saving maternal and newborn care services in the two sub-locations.

The findings and recommendations from this study are important for the attention of policy makers and programme managers in order to improve the state of lower-tier health facilities serving rural communities and to strengthen infrastructure with the aim of making basic routine and emergency obstetric and newborn care services more accessible.

Below:  Map showing Kenyan provinces

Full article at:  http://goo.gl/y23XTk

By: Hildah Essendi^1*, Fiifi Amoako Johnson¹, Nyovani Madise¹, Zoe Matthews¹, Jane Falkingham¹, Abubakr S Bahaj², Patrick James² and Luke Blunden²

¹Department of Social Statistics and Demography, University of Southampton, Southampton, SO17 1BJ, UK

²Engineering and the Environment, University of Southampton, Southampton, SO17 1BJ, UK

 

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Assessing the Performance of Maternity Care in Europe: A Critical Exploration of Tools & Indicators

This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or “normal birth”. The work formed part of COST Actions IS0907: “Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care” (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care.

A structured literature search was conducted of material published between 2005 and 2013, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions.

A total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. Postnatal and neonatal care of mother and baby were the least appraised areas. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or “good” or positive outcomes more generally.

The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes. A physiological birth generally necessitates few, or no, interventions, yet most of the indicators presently applied fail to capture (a) this phenomenon, and (b) the relationship between different forms and processes of care, mode of birth and good or positive outcomes. A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures.

Full article at: http://goo.gl/Jtno43

By: Ramón Escuriet,# Joanna White,# Katrien Beeckman, Lucy Frith, Fatima Leon-Larios, Christine Loytved, Ans Luyben,Marlene Sinclair, Edwin van Teijlingen, and and EU COST Action IS0907. ‘Childbirth Cultures, Concerns, and Consequences’

Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain

Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain

Centre for Research in Anthropology/Centro em Rede de Investigação em Antropologia (CRIA-IUL, Lisbon, Portugal

Department of Health and Social Sciences, University of the West of England, Bristol, UK

Nursing and Midwifery research unit, University hospital Brussels, Vrije universiteit Brussel, Brussel, Belgium

Department of Health Services Research, The University of Liverpool, Liverpool, UK

Departamento de Enfermería. Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain

Zurich University of Applied Sciences, School of Health Professions, Institute of Midwifery, Zurich, Switzerland

Women’s Clinic, Spital STS AG, Thun, Switzerland

Maternal Fetal and Infant Research Centre, University of Ulster, Coleraine, UK

Centre for Midwifery, Maternal & Perinatal Health Bournemouth University, Bournemouth, UK

Ramón Escuriet, Email: tac.tulastac@teirucser.

Contributor Information.

Corresponding author.

^#Contributed equally.

  

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