Introduction maternal and neonatal health status indicators have steadily improved over time in Kenya. Significant challenges remain, including persistent inequities between population subgroups, and a health system that delivers variable quality care and inconsistent access to care. This paper highlights results of an ex-post evaluation to assess the impact of maternal and health systems strengthening intervention to improve newborn health outcomes in Bungoma County, Kenya, focusing on access to and quality of maternal and neonatal care. Methods the study design was quasi-experimental, using household surveys to assess outcomes at baseline and end-line. Stratified cluster sampling was used to identify households, based on heath facility catchment areas. Inclusion criteria were women aged 18-49. Chi-square and fisher´s exact tests were used. Patched-up design was used to compare outcomes before and after the intervention and intervention and control sub-counties. Results provision of transport vouchers decreased barriers to accessto health care, resulting in an increased number of deliveries in health facilities. Women in the end-line group were 95% more likely to deliver at a health facility compared to 74% at baseline. The intervention improved potential and effective access to antenatal care as well as deliveries in health facilities. This positively impacted quality of care provision in the sub-counties. Conclusion key elements of health system strengthening included reducing cost barriers and enhancing the capacity of the health facilities to deliver high quality care. The intervention addressed commonly identified supply-and demand-side barriers, providing stronger evidence that addressing these hindrances would improve utilization of maternal and child health services.
Kenya is estimated to have a population of 47.6 million people. Its maternal and neo natal health indicators have steadily improved over the years. Despite the progress, many significant challenges remain, including persistent inequities between population subgroups, and a health care system that provides variable quality and inconsistent access to care, especially for women and new-borns. Purpose of this paper was to assess the impact of the maternal and new-born improvement intervention in Bungoma County, with a focus on access and quality of maternal and neonatal care services.Methodology: The study design was quasi-experimental, using household surveys to assess outcomes.Findings: Provision of transport vouchers decreased barriers to accessing care, resulting to an increased number of deliveries in health facilities. The health system strengthening intervention possibly had a role in improving potential and actual access to antenatal care and health facility delivery services for mothers as well as positively impacting quality of care provision in the intervention sub-counties. However, actual access for babies (measured by provision of PNC care within 48 hours of delivery) seemed to worsen in the intervention sub-counties.Conclusion: Our analysis suggests that it is possible to conduct an evaluation of the impact of interventions in messy real-life contexts where data availability is challenging. Key elements of health system strengthening include reducing cost barriers and enhancing the capacity of the health facilities to deliver the high quality care. These can fruitfully be implemented in other regions.
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