Introduction
Free Maternal Services
The government introduced free maternal services in all public health facilities across the country. This was necessary in order to address the need of poor mother’s efforts to access the services of skilled birth attendants. The objective of free maternal policy is to improve quality, geographical and financial access to high quality delivery care services. Since the introduction of this policy, we have seen the increase in number of mothers giving birth in hospitals/ health facilities. In financial year 2012/2013, the number of mothers delivering in public hospitals increased from 676,107 to 749,987. The government had disbursed Kshs. 3.2 billion to 301 hospitals and over 2,087 dispensaries and health centers across the country.
Kenya has a vision to provide “equitable and affordable health care at the highest affordable standard” to all citizens. This vision is clearly recorded in the Vision 2030 document. Good health is an essential ingredient in poverty reduction and promoting economic growth as well as realization of social goals. Despite that, most Kenyans cannot afford quality health services. The country continues losing lives to preventable diseases such as malaria and tuberculosis. This has a great negative impact on economic growth.
There is need to improve the health infrastructure in rural and marginalized areas around the country.
The maternal mortality has dropped from 590 per 100,000 live births in 1998 to 414 per 100,000 live births in 2003. This factor is attributed to improved access to healthcare services across the country. There is fear that we will not be able to meet the MDG goal of reducing maternal mortality to 147 per 100,000 live births by 2015.
In the FY 2014/2015, Free Maternity Services was allocated Kshs. 4 Billion. This needs to be increased significantly in order to reduce the high mortality rates experienced in Kenya. Any further increase will also go a long way in reducing disabilities and injuries sustained at child birth. Currently, the mortality rate is 488 deaths per 100,000 live births. The goal is to reduce it to the MDG goal of 147 per 100,000 live births. It is estimated that for every woman who dies during childbirth in Kenya, there are other 20-30 women who suffer fatal injuries caused by complications during delivery or pregnancy.
The challenges facing maternal health services include the fact that most women live a considerable distance from health facilities. In the past, these women could not afford to pay fees for the maternal services. During the Financial Year 2013/2014 the delivery by skilled health workers increased to 66 percent as compared to 44% the previous year. This is a clear indicator of high quality maternal health services. The most recent World Bank report (2013) confirmed that there was a drop in maternal mortality ration from 488 per 100,000 to 400 per 100,000. The target is set at 90% of deliveries to be presided over by a skilled birth attendant by 2015. Currently, traditional birth attendants are providing 21% of the services, friends and relatives assist 21% of the deliveries and 7% of the women giving birth do not get any assistance at all.
The government of Kenya, took an initiative on 1st June, 2013 to assist pregnant mothers when they are giving birth. It initiated Free Maternity Services policy to be implemented in all public health facilities. In just one month after the announcement of the Free Maternity Services, the Director of Public Health and Sanitation estimated that the number of women delivering in health facilities had increased by 10%. In some counties the number increased by 50%. In Kenyatta National Hospital the number of pregnant women seeking maternal care had increased by 100%.
Other causes are:
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· Malaria· Hepatitis· Anemia· Diabetes
The government noted the importance of these free services and committed Kshs 3.8 billion to fund the program starting from July, 2013. In order to support this program well, the government allocated Kshs. 3.1 billion for recruitment of 30 community nurses for every constituency and Kshs. 522 million for recruitment of 10 community health workers for every constituency. This money was allocated from the 2013/2014 national budget. The county governments were allocated Kshs. 60 billion for provision of health services. Despite the factor that the sector was allocated a total of Kshs. 95 billion, it is still not adequate to provide services to the citizens due to increased pressure from people due to the introduction of Free Maternal Services.
In the FY 2014/2015, Free Maternity Services was allocated Kshs. 4 Billion. The amount allocated for this program needs to be increased significantly in order to reduce the high mortality rates experienced in Kenya.
Critics of Free Maternal Services have expressed their concerns that the policy may lead to decline in quality of Maternal Services provided by the public healthcare facilities. If the policy is not funded well and implemented appropriately, it may lead to human rights violations in the public health facilities.
The Kenya National Patients’ Rights Charter (2013) provides that patients have the right to receive emergency treatment irrespective of whether they are able to pay and the right to access healthcare among others.
The Free Maternal Services are in line with the Committee on Elimination of Discrimination Against Women (CEDAW) which indicates that women have a right to access services related to pregnancy, post-natal care and child-birth. Kenya adopted the Free Maternal Services in order to try to achieve the Millennium Development Goals.
Kenya has joined Burkina Faso, Liberia, Burundi, Zambia, Sudan and Niger in offering free delivery services to mothers. These diminishing funds in the health sector would seriously compromise the Free Maternity Services Program.
The other challenge which is facing the program is the slow disbursement of funds to the health facilities. Some facilities have also reported unfairness in the distribution of funds for this program. Some healthcare facilities receive excess funds to handle the increased influx of women seeking maternal services while other facilities receive very little leaving them wondering on how to handle the implementation of this policy. The reimbursement is not sufficient
Challenges
For the Financial year 2014/2015, Kenya had allocated Kshs. 95 billion to health sector. This is 6.5% of the total budget. It is far below the 15 percent set by the Abuja Declaration where Kenya is a party.
The Jubilee government manifesto promised to progressively increase the amount allotted to health sector in order to reach the 15% target. Despite making that promise, the government has been reducing the percent from 7.2% in 2010 to 6.1% in 2011 and 5.9% in 2012. This is not a good trend and it means that we will not reach the goals set by Abuja Declaration.
According to the 2015 Draft Budget Policy Statement, the government has allocated Kshs. 4.618 billion to be spent on Free Maternal Services. The amount was increased by Kshs. 618 million. This money will not be enough to efficiently support the program. According to data from UNICEF, the Annual number of births in Kenya was 1,534,390 in 2012. Three years down the line the number of annual child births can be extrapolated to 1,688,390 by 2015. The Free Maternity Service will require a minimum of Kshs. 8, 441, 95000 to cover basic services. In 2014/2015, hospitals such as Pumwani Maternity reported that the government reimbursed them with Kshs. 5,000 for all child births despite the fact that caesarian section costs Kshs 15,000.
Infrastructure and staffing
Since independence, Kenya’s public health facilities have been associated with inadequacy in staffing. According to Vision 2030, there are just 14 physicians for every 100,000 Kenyans. This situation needs to be improved significantly. World Bank reports that Kenya has only 7 nurses per 4,000 citizens. This is just half of World Bank’s recommended 14 nurses per 4,000 people. The other problem is that these health workers are unevenly distributed across the country. The most recent surveys indicated that 36% of healthcare facilities are well equipped to offer delivery services.
Recommendations
· We as recommend the National Treasury to increase the allocation for Free Maternal Services to a minimum of Kshs. 8,441,950,000in the FY 2015/2016. This is the amount of money that is required to achieve the 2015 target of 90% pregnant women seeking Maternal Services.
· The money can be raised by increasing the requirements of the conditional grant. The counties should be required to match the grant with more funds. This will help them reduce on unnecessary expenditure such us on luxury motor vehicles and palatial residences for senior county officials.
References
Vision 2030
2015 draft budget policy statement
Health sector working group
UNICEF data on health (http:/www.unicef.org/infobycountry/Kenya_statistics.html)
(Note: All the ideas presented in here are my own views)
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