Awareness and Utilization of Free Maternal Healthcare Services among Women in Mt. Elgon Sub-County, Kenya

  • Oliver Furechi Maseno University
Keywords: Free Health Care, Maternal, Neonatal, Cost, Kenya
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Abstract

Maternal mortality remains a matter of public health concern with over 300,000 women dying while giving birth annually. This has driven policymakers to come up with free maternal healthcare services as policy interventions. The Kenyan Government adopted the free maternal healthcare policy in 2013. The policy exempted maternal services from user fees in all public health facilities—the policy aimed at promoting skilled delivery to reduce pregnancy-related mortality.  In the Mt Elgon sub-county, only 45% of women delivered in a health facility, this was below the national average of 61.5 percent. This paper presents results from a cross-sectional study conducted in January 2021 in Mt Elgon Sub-County among 377 randomly selected women who had delivered in the preceding 12 months and 4 FGDs with women of reproductive age. Descriptive statistics were undertaken while the Chi-Square test was used for inferential statistics. Andersen’s behavioural model of health services use was utilized to examine how women’s demographic characteristics and awareness regarding the free maternal health policy had affected the utilization of maternal healthcare services. The results indicate that respondents were generally aware of the government's free maternal health policy. However, gaps still existed in terms of pushing awareness towards universal reach, infrastructure development, health worker-patient ratio, timely provision of essential supplies and long distance to health facilities. This calls for increased sensitization utilizing community health volunteers and allocation of financial and human resources allocation to the department of health within County Governments

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References

Achoki, T., Miller-Petrie, M. K., Glenn, S. D., Kalra, N., Lesego, A., Gathecha, G. K., Alam, U., Kiarie, H. W., Maina, I. W., Adetifa, I. M. O., Barsosio, H. C., Degfie, T. T., Keiyoro, P. N., Kiirithio, D. N., Kinfu, Y., Kinyoki, D. K., Kisia, J. M., Krish, V. S., Lagat, A. K., … Naghavi, M. (2019). Health disparities across the counties of Kenya and implications for policy makers, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Global Health, 7(1), e81–e95. https://doi.org/10.1016/S2214-109X(18)30472-8

Ahmed, A. K., & Agbana, B. E. (2015). Assessment of awareness, perception and utilization of health services among patients attending clinic at the Muslim Ummah Hospital, Kisi, South-west, Nigeria. Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria, 24(1), 37–41.

Åkerman, E., Larsson, E. C., Essén, B., & Westerling, R. (2019). A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden. Sexual & Reproductive Healthcare: Official Journal of the Swedish Association of Midwives, 19, 64–70. https://doi.org/10.1016/j.srhc.2018.12.005

Al-Rayes, S. A., Aldossary, H., Aldoukhi, E., Alahmedalyousif, Z., Aldawood, G., & Alumran, A. (2020). The awareness and utilization of 937-telephone health services in Saudi Arabia: Cross-sectional survey study. Informatics in Medicine Unlocked, 20, 100393. https://doi.org/10.1016/j.imu.2020.100393

Andersen, R. M., & Davidson, P. L. (2007). Improving Access to Care in America: Individual and Contextual Indicators. In Changing the U.S. health care system: Key issues in health services policy and management, 3rd ed. (pp. 3–31). Jossey-Bass.

Azaare, J., Akweongo, P., Aryeetey, G. C., & Dwomoh, D. (2020). Impact of free maternal health care policy on maternal health care utilization and perinatal mortality in Ghana: Protocol design for historical cohort study. Reproductive Health, 17(1), 169. https://doi.org/10.1186/s12978-020-01011-9

Baker, J. B., & Liu, L. (2006). The determinants of primary health care utilization: A comparison of three rural clinics in Southern Honduras. GeoJournal, 66(4), 295– 310. https://doi.org/10.1007/s10708-006-9001-8

Calhoun, L. M., Speizer, I. S., Guilkey, D., & Bukusi, E. (2018). The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya. Maternal and Child Health Journal, 22(3), 409– 418. https://doi.org/10.1007/s10995-017-2408-7

Carlough, M., & McCall, M. (2005). Skilled birth attendance: What does it mean and how can it be measured? A clinical skills assessment of maternal and child health workers in Nepal. International Journal of Gynecology & Obstetrics, 89(2), 200–208. https://doi.org/10.1016/j.ijgo.2004.12.044

Chen, C.-C., Lin, Y.-J., & Lin, Y.-T. (2013). Awareness and utilization of preventive care services among the elderly under National Health Insurance. International Journal of Health Care Finance and Economics, 13(3–4), 247–260. https://doi.org/10.1007/s10754-013-9128-3

Chimankar, D. A., & Sahoo, H. (2011). Factors influencing the Utilization of Maternal Health Care Services in Uttarakhand. Studies on Ethno-Medicine, 5(3), 209– 216. https://doi.org/10.1080/09735070.2011.11886411

Feikin, D. R., Nguyen, L. M., Adazu, K., Ombok, M., Audi, A., Slutsker, L., & Lindblade, K. A. (2009). The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Tropical Medicine & International Health, 14(1), 54–61. https://doi.org/10.1111/j.1365-3156.2008.02193.x

Feng, N., Jin, X., Wu, J., & Wang, L. (2020). Promotion of awareness and utilization of youth friendly service through multi-sectoral cooperation mechanism in China. BMC Public Health, 20(1), 747. https://doi.org/10.1186/s12889-020-8313-9

Gitimu, A., Herr, C., Oruko, H., Karijo, E., Gichuki, R., Ofware, P., Lakati, A., & Nyagero, J. (2015). Determinants of use of skilled birth attendant at delivery in Makueni, Kenya: A cross sectional study. BMC Pregnancy and Childbirth, 15(1), 9. https://doi.org/10.1186/s12884-015-0442-2

Gitobu, C. M., Gichangi, P. B., & Mwanda, W. O. (2018). The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC Pregnancy and Childbirth, 18(1). https://doi.org/10.1186/s12884-018-1708-2

hIarlaithe, M. O., Grede, N., de Pee, S., & Bloem, M. (2014). Economic and Social Factors are Some of the Most Common Barriers Preventing Women from Accessing Maternal and Newborn Child Health (MNCH) and Prevention of Mother-to-Child Transmission (PMTCT) Services: A Literature Review. AIDS and Behavior, 18(5), 516– 530. https://doi.org/10.1007/s10461-014-0756-5

Kenya National Bureau of Statistics. (2014). Kenya Demographic and Health Survey 2014. https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf

Lambon-Quayefio, M. P., & Owoo, N. S. (2014). Examining the Influence of Antenatal Care Visits and Skilled Delivery on Neonatal Deaths in Ghana. Applied Health Economics and Health Policy, 12(5), 511–522. https://doi.org/10.1007/s40258-014-0103-z

Lang’at, E., Mwanri, L., & Temmerman, M. (2019). Effects of implementing free maternity service policy in Kenya: An interrupted time series analysis. BMC Health Services Research, 19(1), 645. https://doi.org/10.1186/s12913-019-4462-x

Masaba, B. B., & Mmusi-Phetoe, R. M. (2020). Free Maternal Health Care Policy in Kenya; Level of Utilization and Barriers. International Journal of Africa Nursing Sciences, 13, 100234. https://doi.org/10.1016/j.ijans.2020.100234

Masiye, F., Kaonga, O., & Kirigia, J. M. (2016). Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia. PLOS ONE, 11(1), e0146508. https://doi.org/10.1371/journal.pone.0146508

Mbugua, S., & MacQuarrie, K. (2018). Determinants of Maternal Care Seeking in Kenya. DHS Further Analysis Reports No. 111. (111). ICF. https://dhsprogram.com/pubs/pdf/AB3/FA111.pdf

Mohan, D., Gupta, S., LeFevre, A., Bazant, E., Killewo, J., & Baqui, A. H. (2015). Determinants of postnatal care use at health facilities in rural Tanzania: Multilevel analysis of a household survey. BMC Pregnancy and Childbirth, 15(1), 282. https://doi.org/10.1186/s12884-015-0717-7

Mulyanto, J., Kunst, A. E., & Kringos, D. S. (2019). Geographical inequalities in healthcare utilisation and the contribution of compositional factors: A multilevel analysis of 497 districts in Indonesia. Health & Place, 60, 102236. https://doi.org/10.1016/j.healthplace.2019.102236

Nansseu, J. R. N., Nchinda, E. C., Katte, J.-C., Nchagnouot, F. M., & Nguetsa, G. D. (2015). Assessing the knowledge, attitude and practice of family planning among women living in the Mbouda health district, Cameroon. Reproductive Health, 12(1), 92. https://doi.org/10.1186/s12978-015-0085-9

Nuamah, G. B., Agyei-Baffour, P., Mensah, K. A., Boateng, D., Quansah, D. Y., Dobin, D., & Addai-Donkor, K. (2019). Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana. BMC Pregnancy and Childbirth, 19(1), 6. https://doi.org/10.1186/s12884-018-2159-5

Ocholla, I. A., Agutu, N. O., Ouma, P. O., Gatungu, D., Makokha, F. O., & Gitaka, J. (2020). Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya. BMC Pregnancy and Childbirth, 20(1), 287. https://doi.org/10.1186/s12884-020-02977-x

Organization, W. H. (2019). Trends in maternal mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization. https://apps.who.int/iris/handle/10665/327595

Rutaremwa, G., Wandera, S. O., Jhamba, T., Akiror, E., & Kiconco, A. (2015). Determinants of maternal health services utilization in Uganda. BMC Health Services Research, 15. https://doi.org/10.1186/s12913-015-0943-8

Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A.-B., Daniels, J., Gülmezoglu, A. M., Temmerman, M., & Alkema, L. (2014). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X

Tama, E., Molyneux, S., Waweru, E., Tsofa, B., Chuma, J., & Barasa, E. (2017). Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation. International Journal of Health Policy and Management, 7(7), 603–613. https://doi.org/10.15171/ijhpm.2017.135

Thongmixay, S., Essink, D. R., Greeuw, T. de, Vongxay, V., Sychareun, V., & Broerse, J. E. W. (2019). Perceived barriers in accessing sexual and reproductive health services for youth in Lao People’s Democratic Republic. PLOS ONE, 14(10), e0218296. https://doi.org/10.1371/journal.pone.0218296

Wagstaff, A., & Claeson, M. (2004). The Millennium Development Goals for Health: Rising to the Challenges. In World Bank Publications. The World Bank. https://ideas.repec.org/b/wbk/wbpubs/14954.html

WHO. (2012). Barriers and Facilitating Factors in Access to Health Services in the Republic of Moldova. 135.

Yamane, T. (1967). Statistics: An Introductory Analysis (2nd ed.). Harper and Row.

Zelalem Ayele, D., Belayihun, B., Teji, K., & Admassu Ayana, D. (2014, October 29). Factors Affecting Utilization of Maternal Health Care Services in Kombolcha District, Eastern Hararghe Zone, Oromia Regional State, Eastern Ethiopia [Research Article]. International Scholarly Research Notices; Hindawi. https://doi.org/10.1155/2014/917058

Published
13 December, 2024
How to Cite
Furechi, O. (2024). Awareness and Utilization of Free Maternal Healthcare Services among Women in Mt. Elgon Sub-County, Kenya. East African Journal of Health and Science, 7(2), 157-166. https://doi.org/10.37284/eajhs.7.2.2517