Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study

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Abstract

Background

Globally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013.

Methods

A qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis.

Results

Free maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy.

Conclusion

Free maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.

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Most cited references 40

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Qualitative data analysis for applied policy research

Jane Ritchie, Liz Spencer (1994)

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Too far to walk: maternal mortality in context.

S Thaddeus, D Maine (1994)

The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality--alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an obstetric emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources.

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A standardized approach to qualitative content analysis of focus group discussions from different countries.

Francesca Moretti, Liesbeth van Vliet, Jozien Bensing … (2011)

To describe the methodological procedures of a multi-centre focus group research for obtaining content categories also suitable for categorical statistical analyses. Inductive content analyses were performed on a subsample of 27 focus groups conducted in three different countries, the Netherlands (Utrecht), the UK (Liverpool) and Italy (Verona). The analyses of the subsample of focus group discussions were performed in five steps: (1) independent development of content categories in each of the participating centres, (2) obtaining consensus categories, (3) creation of a manual with coding rules and defining criteria for categories and subcategories, (4) assessment of inter-rater reliability to identify unreliable categories to be revised, and (5) repetition of inter-rater reliability assessment. The resulting coding system considers five areas: non verbal communication, process oriented expression, task oriented or problem focused expressions, affective or emotional expressions, and physician's personal characteristics. It contains 12 categories of acceptable inter-rater reliability and 41 subcategories. The coding procedures show how focus group data, obtained in an international multi-centre study can be analysed in a systematic way combining scientific rigour with the richness of data obtainable from qualitative methodologies. The applied procedures may be helpful for multi-centre focus group research on other topics. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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Author and article information

Contributors

Evaline Lang’at: +61 8 7221 8425 , public.health@flinders.edu.au , langat.eva@gmail.com

Lillian Mwanri: lillian.mwanri@flinders.edu.au , public.health@flinders.edu.au

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 27 June 2015

Publication date PMC-release: 27 June 2015

Publication date Collection: 2015

Volume: 12

Electronic Location Identifier: 59

Affiliations

[ ]Discipline of Public Health, School of Health Sciences, Faculty of Nursing, Medicine and Health Sciences, Flinders University, SA, Level 2 Health Sciences Building Registry Road Bedford Park, SA 5042 Flinders, Australia

[ ]Ministry of Health, Kenya. Kilifi County Government, GPO Box 9–80108, Kilifi, Kenya

Article

Publisher ID: 48

DOI: 10.1186/s12978-015-0048-1

PMC ID: 4482051

PubMed ID: 26116432

SO-VID: 2a3f9f56-1efb-4471-ae9f-1f2e4277376a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 3 October 2014

Date accepted : 10 June 2015

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: free maternal healthcare service policy,healthcare providers,facility administrators,malindi district,kenya

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: free maternal healthcare service policy, healthcare providers, facility administrators, malindi district, kenya

Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study

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Advocacy for Maternal and Women’s Health

Most cited references 40

Qualitative data analysis for applied policy research

Too far to walk: maternal mortality in context.

A standardized approach to qualitative content analysis of focus group discussions from different countries.

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