IntroductionIn Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district.MethodsThis was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan district. The information was collected through a pretested interview schedule.ResultsThe median age of the study participants was 28 years. Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8). Those with tertiary education were more likely to take up insurance AOR 5.1 (1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake.ResultsBeing married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low and may provide a basis for policy changes among the insurance companies to increase the uptake.

Introduction: Quality of care is acknowledged as a critical facet of the unfinished maternal and newborn health agenda. Yet modalities of reorienting maternity services to respectful services are rare. This study investigated the effect of training health workers in cultural competence towards satisfaction with maternity service. Materials and Methods: This was a Cluster Randomized Controlled Trial undertaken in public hospitals. The intervention was provision of culturally sensitive maternity services by health workers after cultural competence training. Three hundred and seventy nine women were interviewed per group using exit and mystery client surveys. The effect was measured using standard mean difference (Cohen’s d) and t-test. Results: There was significant effect on satisfaction with provided information on delivery methods (F (1, 756) = 11.493, p < 0.001, ηp2 = .049). The mean of intervention group increased from 3.55 ±1.056 to 3.94, ±0.894 while the control changed from 3.57±1.187 to 3.62 ± 1.149. The mean changes tweaked the group variance from insignificant t (725) =0.290, p = 0.771 to significant t (713) =-4.336 p <0.001. Conclusion: Cultural competence training is effective in creating room for desired maternal needs and improving perceived satisfaction with maternity services. Consequently, there is a need to integrate cultural knowledge and skills into existing maternal policies and training.

Background This study set out to investigate how incentives for mothers, health workers and boda–boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda. Both the monetary and non-monetary incentives have been instrumental in the improvement of deliveries at health centres. Methods The study was a 2 arm cluster non-randomized control trial study design; with intervention and control groups of mothers, health workers and boba–boda (commercial motor-cycle) riders from selected health centres and communities in Busoga region. Among the study interventions was the provision of incentives to mothers, health workers (midwives and VHTs) and boda–boda riders for a duration of 6 months. Monetary and non-monetary incentives were applied in this study, namely; provision of training, training allowances, refreshments during the training, payment of transport fares by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group (CUG) and provision of bonus airtime to all registered CUG participants and rewards to best performers. The study used a mixed methods design. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data. Results Findings revealed that incentives improved community-based referrals and health facility deliveries in the rural community of Busoga. The proportion of mothers who delivered from health centres and used boda–boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the mothers who delivered from the health centres, majority (69.4%) were transported by trained boda–boda riders while only 30.6% were transported by un-trained boda–boda riders. And of the mothers transported by the boda boda riders, 21.3% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4.3% before the intervention. Mothers who were responded to between 21–30 min increased from 31.4% to 69.6% in the intervention arm while in the control arm, it only increased from 37.1% to a dismal 40.3%. Interestingly, as the time interval increased, the number of boda–boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda–boda riders took as many as 31–60 min’ time interval to respond to their calls in post intervention compared to a whopping 54.9% in the pre intervention time. There was little change in the control arm from 53.2% in the pre intervention to 41.2% in the post intervention. Conclusion Incentives along the maternal health chain are key and the initiative of incentivising the categories of stakeholders (mothers, midwives, the VHTs and the boda–boda riders) has demonstrated that partnerships are very critical in achieving better maternal outcomes (health facility-based deliveries) as a result of proper referral processes.

Background: In Kenya today, public health facilities at different levels collect a large amount of routine health (RH) data. However, with the introduction of district health information software (DHIS2), recent evidence has shown low levels of data are used by the targeted stockholders in Kenya. The therefore study aims to examine the association of human resource and information technology factors associated with the frequent use of RH data in decision-making among health-workers in Marsabit county.Methods: The study employed a cross-sectional design. Researchers purposively stratified 201 health workers by cadre, then probability proportionate sampling was applied to get the required number from every cadre. Both qualitative and quantitative data were collected and entered into the SPSS software, descriptive measurement and Chi square test were used to analyze the dataResults: The majority (74%) of respondents had basic computer skills but 80% of respondent lacked training in health information management. The study found that training increases the likelihoods of healthcare workers utilizing RH data. The type of software (DHIS2 and MedBoss) in use had a significant association with the frequent use of RH data at a p (0.047<0.05).Conclusions: The study revealed that the health facilities lacked ample IT accessories even though internet and electricity connectivity was not limited, however, RHI use was not optimal in health facilities. The study found that the majority of respondents lacked training in RH data implying that training may influence the overall use of the routine data. The study also observed that RH data were used for decision-making frequently for a range of management functions.

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