Evaluation of financial adequacy of the free maternity policy in Kenya: A case study of Kenyatta National Hospital

Abstract

Background: In a bid to reduce maternal mortality in Kenya and encourage women to have deliveries in healthcare facilities, the  Government of Kenya introduced free maternity services at all public hospitals. The implementation of the poli has since been faced with  a number of challenges, key among them, financial adequacy.

Objectives: To evaluate the financial adequacy of the free maternity policy in Kenya and characterize admissions before and after  implementation of the policy

Study Design: Quasi experimental.

Setting: Kenyatta National Hospital

Subjects and Intervention: Admission and financial records of women seeking care at the Kenyatta National Hospital labor ward unit for  control and experimental groups.

Results: Admissions rose from 28,824 in the control period and 6,872 of these admissions underwent caesarean section yielding a  caesarean section rate of 23.8% to 34,858 in the corresponding period in 2014/ 2015 after the free maternity policy was introduced  representing a 20.9% increase and 9,377 caesarean sections (C/S) were conducted representing a 26.9% caesarean section rate for the year 2014/ 2015 and a 36.5% increase in caesarean sections relative to 2010/ 2011. The mean monthly admissions in maternity increased  by 11.6% while and that of C/S by 32.8%. The ratio of delivery cost to reimbursements was 20% higher for normal deliveries, 2.6 times  higher for C/S, and between 2.34- and 2.8-fold higher in deliveries without and with complications, respectively.

Conclusion: Hospitals are  facing financial constraints due to an increased number of admissions without commensurate financial remittances for the free maternity services policy.