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The Impact of Delivery Fees Exemption Policy on Maternal Death Rates at Nakuru County Referral Hospital

Gacaga Peter Mungai*, Nicholus Muraguri

Background: The reduction and elimination of pregnancy-related mortality remain a challenge in most low income countries. For this reason, many African countries have either reduced or eliminated delivery fees to promote health facility delivery service utilization. Healthcare seeking behavior is a central issue in service delivery. Cost has been highlighted as a major hindrance to utilization of medical services especially among the poor people. It has been shown that removal or reduction of user fees results to increased utilization of services. However, some studies have shown the opposite to be true. Following the free maternity services policy in Kenya, uninterrupted time series study was conducted in Nakuru County referral hospital to examine the effects of the policy on utilization of maternity services at the hospital and the effects on maternal and neonatal deaths.

Study aims: The impact of delivery fees exemption policy on maternal death rates at Nakuru County Referral Hospital.

Methodology: Data was collected from facility-based records using a predesigned standard data extraction form Data analysis: The study used Interrupted Time Series Analysis (ITSA), a strong longitudinal quasi-experimental design with a single group to assess the effects of the Free Maternity Service Policy to maternal health. The three indicators were observed 24 months pre (June 2011–May 2013) and 24 months post (June 2013–May 2015) free maternity service policy implementation, giving a total of 48 observations.

Findings: There was a statistically significant increase in the number of skilled deliveries, significant reduction in neonatal mortality rates and a non-significant reduction in the maternal mortality ratio.

Conclusion: These findings suggest that cost significantly limits access to skilled deliveries in Kenya thus the free maternity policy can successfully promote utilization of facility deliveries. However, free maternity alone cannot address maternal and neonatal mortalities thus there is needed to address other determinants of maternal and neonatal deaths such as the health service infrastructure and cultural practices.