Impact of free maternity health services on quality of care to women presenting with late obstetric haemorrhage at Kenyatta National Hospital

Abstract

Background: Obstetric hemorrhage is the leading cause of pregnancy – related mortality worldwide. Free maternity care in Kenya was introduced as a step to improve maternal and neonatal outcomes.

Objectives: To compare the quality of care offered to women presenting with late obstetric hemorrhage at Kenyatta National Hospital before and after the implementation of the free maternity care policy in Kenya.

Study Design: A quasi-experimental study.

Setting: Kenyatta National Hospital Labour Unit.

Subjects and Intervention: Women presenting with late obstetric haemorrhage at the Kenyatta National Hospital one year before and one year after implementation of the free maternity care policy in Kenya.

Results: No major changes in resource availability and staffing during the two periods were noted. Significant improvements in the post-intervention period were noted in documentation of vital signs, decision of mode of delivery and patient severity classification while recording fundal height, admission character of fetal heart rate (FHR), vaginal examination findings (VE), and results of HIV testing declined. The prevalence of uterine rupture and postpartum hemorrhage as causes of obstetrical hemorrhage increased in the post intervention period while the median duration between decision to conduct caesarian section and delivery increased from 70 minutes to 110 minutes in the post intervention period as did post caesarean section complications.

Conclusion: Quality of care declined with the introduction of free maternity services in Kenya as resources remained constant while patient loads increased which affected care resulting in increases in adverse outcomes and post caesarian section complications.