Evaluation of cost of delivery and post-delivery complications before and after implementation of free maternity policy in Kenya

Abstract

Background: The Government of Kenya availed nearly US$ 7 million for compensation to healthcare facilities after removal of all user fees in public dispensaries and health centers, and implemented a free maternity care policy, in a bid to reduce 6,300 maternal deaths in Kenya.

Objectives: To determine the number and cost of normal deliveries, caesarian section, and delivery-related complications before and after policy implementation

Study Design: Quasi-experimental design

Setting: Kenyatta National Hospital

Subjects and Intervention: Financial records of women seeking care at the Kenyatta National Hospital labor ward unit for the periods (June 1st, 2010, to May 31st, 2012) and (June 1st, 2014 to May 31st, 2015). The intervention was a free maternity policy.

Results: The mean cost for normal deliveries in the control group was Kshs. 6,528.4 (SD 2,593.7) and Kshs. 21,063.3 (SD 9,473.7) in the experimental group. Hospital bills increased significantly after the free maternity services introduction from a median bill of Kshs. 5,777.5 to Kshs. 19,624. The mean caesarean section hospital bills were Kshs 21, 949 in the controls compared to an average cost of Kshs 46,079 in the experimental group. The mean costs of delivery-related complications in the pre-intervention and post-intervention groups were Kshs 20, 490, and Kshs 48, 919, respectively.

Conclusion: Free maternity services introduction was significantly associated with an increase in costs of normal deliveries, caesarian sections, and costs related to post-delivery complications. However, there has been a decline in budget allocation to health specifically free maternity, hence an imbalance between demand and supply.