BackgroundQuality of healthcare is an important determinant of future progress in global health. However, the distributional aspects of quality of care have received inadequate attention. We assessed whether high quality maternal care is equitably distributed by (1) mapping the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya; and (2) comparing the quality of maternal care available to Kenyans in and not in poverty.MethodsWe assessed three measures of maternal care quality: facility infrastructure and clinical quality of antenatal care and delivery care, using indicators from the 2010 Kenya Service Provision Assessment (SPA), a standardized facility survey with direct observation of maternal care provision. We calculated poverty of the area served by antenatal or delivery care facilities using the Multidimensional Poverty Index. We used regression analyses and non-parametric tests to assess differences in maternal care quality in facilities located in more and less impoverished areas. We estimated effective coverage with a minimum standard of care for the full population and those in poverty.ResultsA total of 564 facilities offering at least one maternal care service were included in this analysis. Quality of maternal care was low, particularly clinical quality of antenatal and delivery care, which averaged 0.52 and 0.58 out of 1 respectively, compared to 0.68 for structural inputs to care. Maternal healthcare quality varied by poverty level: at the facility level, all quality metrics were lowest for the most impoverished areas and increased significantly with greater wealth. Population access to a minimum standard (≥0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care.ConclusionThe quality of maternal care is low in Kenya, and care available to the impoverished is significantly worse than that for the better off. To achieve the national targets of maternal and neonatal mortality reduction, policy initiatives need to tackle low quality of care, starting with high-poverty areas.

Reaching the United Nation's Millennium Development Goals has been a focus for many countries and development partners. In Kenya, as in many other countries with low levels of development, access to and equity of basic quality health services is limited, especially for the very poor. Among poor populations, maternal mortality is high as access to medical care and financial means are lacking. In 2005, the Governments of Kenya and Germany in cooperation with KfW Banking Group made funds available for the Reproductive Health OBA Voucher Programme offering vouchers for Safe Motherhood, Family Planning and Gender Violence Recovery Services. This programme, herein referred to as Vouchers for Health, was launched in June of 2006 in five Kenyan districts with the aim of providing health services for safe deliveries, long-term family planning methods and victims of gender violence. The way that the programme is being implemented in Kenya demonstrates that the voucher-based approach comprises a variety of key structural elements of a national health insurance scheme: accreditation; quality assurance; reimbursement system; claims processing; integrating the private sector; client choice; provider competition; and access to and equity of services provided.

We assessed whether quality of maternal and newborn health services is influenced by presence of HIV programs at Kenyan health facilities using data from a national facility survey. Facilities that provided services to prevent mother-to-child HIV transmission had better prenatal and postnatal care inputs, such as infrastructure and supplies, and those providing antiretroviral therapy had better quality of prenatal and postnatal care processes. HIV-related programs may have benefits for quality of care for related services in the health system.

The impacts of climate change on vector-borne and zoonotic diseases (VBZD) are well founded in some countries but remain poorly understood in Caribbean countries. VBZD impose significant burdens on individuals and healthcare systems, heightening the need for studies and response measures to address epidemics and persistent high prevalence of these diseases in any region. This study analyses the pattern of dengue case distribution in Grenada between 2010–2020 and investigates the relationship between rainfall and cases. The total number of dengue cases in the wet seasons (June to December) and dry seasons (January to May) were 1741 and 458, respectively, indicating higher prevalence of the disease in wet periods. The data also shows that rainfall was not consistently higher during the typical rainy season months. The observed patterns in 2013, 2018 and 2020 show, while these were the driest years, the number of cases were higher than in other years. Two factors may explain high number of cases in the drier years (1) frequent sporadic heavy rainfall and (2) poor water storage practices in dry season. With each 30 mm unit decrease in annual rainfall, the incidence rate ratio of dengue was reduced by a factor of .108 (89.2%). The work of the Vector Control Unit is shown to be effective in managing dengue in Grenada. The study highlights the need for year-round surveillance and interventions to control the mosquito population and dengue transmission.

No abstract