Improving Access to Maternal Health Care through Devolution in Western Kenya

Kilonzo, Susan M.; Kamaara, Eunice; Magak, Kitche

doi:10.19088/1968-2017.118

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…This finding reaffirms result of a perspective survey showing possible impact of devolved health care in Kenya as increasing uptake of maternal service at referral service, which besides devolution was attributed also to improving transport and free maternity programme (Kilonzo, Kamaara, & Magak, 2017). It shows that quality overrides distance in health seeking and provider choices.…”

Section: Discussion Of Resultssupporting

confidence: 79%

Spatial Equity in Devolved Healthcare: Geospatially Exploring Local Disparities in Maternal Healthcare Uptake After Devolution in Kenya

Nyangueso

Hayombe

Owino

2018

ESJ

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Devolved healthcare in Kenya was to ensure provision of proximate and easily accessible services throughout the Country, thereby improving local uptake as an outcome from patient perspective. Over five years after operationalization of the devolved healthcare, it isn’t certain whether or not there have been reducing spatial disparities and/or improving prospects of spatial equity in local utilizations of essential primary healthcare. The paper seeks to explore spatial disparities in maternal healthcare utilization and prospects of realising spatial equity after devolution of healthcare in Kenya. County of Siaya and 30 Wards therein were, respectively, selected as spatially heterogeneous and homogenous multiple cases for the study through retrospective patient-based surveys. The study leveraged on Kenyan webbased health information systems to capture spatial and attribute data on skilled birth attendance and antenatal care before and after devolution by each of the 220 registered health facility the County by Wards. Local utilization ratio, a new innovative indicator, was applied to effectively measure and analyse the spatial disparities in maternal healthcare through ordinary least square spatial regression analysis within spatio-temporal analysis realm using ArcGIS 10.3. Result showed significant positive spatial relationship in maternal service utilizations before and after devolution by Wards (p<0.01, R 2>90%). but stagnating or deteriorating spatial disparities irrespective of either increasing or decreasing uptake of the services. This trend points to lower prospects by devolved healthcare in realizing spatial health equity without improving quality and comprehensiveness of primary health services in Siaya County and related decentralised units in Kenya and beyond.

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Section: Discussion Of Resultssupporting

confidence: 79%

Spatial Equity in Devolved Healthcare: Geospatially Exploring Local Disparities in Maternal Healthcare Uptake After Devolution in Kenya

Nyangueso

Hayombe

Owino

2018

ESJ

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“…Another limitation of this quasi-experimental study design is that we are attributing observed changes over time to the voucher programme and free maternity services policy; however, our findings may have also been affected by other programmes, policies and events in our study counties. For instance, since 2013, the Kenyan health system has experienced a number of challenges related to the decentralization of government and removal of user fees for maternal care, which are perceived to have contributed to reduced quality of care and unauthorized fees in some facilities (Nyikuri et al , 2015; Barasa et al , 2017; Kilonzo et al , 2017; Tama et al , 2017; Tsofa et al , 2017). Additionally, concerns about salary delays, inadequate staffing and job insecurity led to multiple health worker strikes since the policy changes (Nyikuri et al , 2015; Kilonzo et al , 2017).…”

Section: Discussionmentioning

confidence: 99%

Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

Dennis

Beňová

Abuya

et al. 2019

Health Policy and Planning

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This study explores the relationship between two health financing initiatives on women’s progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006–16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1.33, P = 0.014]. Early ANC initiation (aOR: 1.32, P = 0.001) and use of private sector ANC (aOR: 1.93, P < 0.001) were also positively associated with use of continuous care among ANC users. Among continuous care users, early ANC was associated with increased odds of completing the maternal health pathway as recommended (aOR: 3.80, P < 0.001). Higher parity was negatively associated with all three outcomes, while having health insurance was positively associated with each outcome. The impact of other sociodemographic factors such as maternal age, education, wealth quintile, urban residence, and employment varied by outcome; however, the findings generally suggest that marginalized women faced greater barriers to early ANC initiation and continuity of care. Health financing and women’s timing and source of ANC are strongly related to their subsequent progression through the maternal health pathway. To increase continuity of care and improve maternal health outcomes, policymakers must therefore focus on equitably reducing financial and other barriers to care seeking and improving quality of care throughout the continuum.

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“…The negative impact is generally seen in studies that have measured social perspectives. This excludes one qualitative study (Kilonzo et al, 2017), whose findings showed a positive view of the impact of devolution on access to maternal healthcare by the users.…”

Section: Introductionmentioning

confidence: 92%

Does Decentralization Improve Provision of Health Services? Evidence from Kisumu and Makueni Counties in Kenya

Makokha¹

2018

Preprint

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The last five decades have seen uncountable debates on the impact of decentralization on provision of public services. While it has evidently improved public service delivery in some countries, it has worsened it in others. Kenya implemented devolution in 2013 in the hope of bringing public services nearer to the people. Health was one of the services identified. Yet, the local media has reported negative impact of devolution on provision of health services since 2013. This study sought to look at the actual effect of devolution on access to health care services by analysing secondary quantitative data from the government published data, official statistics, international development agencies’ surveys and reports. Two county governments; Kisumu and Makueni were chosen to represent the urban and rural populations respectively. Contrary to the wider literature on health decentralization, this study found out that devolution did not worsen access to health care services in Kenya. The study attributed this to the nature of devolution adopted in the country where the county governments have considerable authority, decision-making power and responsibility over their counties.

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Improving Access to Maternal Health Care through Devolution in Western Kenya

Cited by 10 publications

References 7 publications

Spatial Equity in Devolved Healthcare: Geospatially Exploring Local Disparities in Maternal Healthcare Uptake After Devolution in Kenya

Spatial Equity in Devolved Healthcare: Geospatially Exploring Local Disparities in Maternal Healthcare Uptake After Devolution in Kenya

Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

Does Decentralization Improve Provision of Health Services? Evidence from Kisumu and Makueni Counties in Kenya

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