Free Maternity Services: A blessing or curse?

It’s now almost six months since the Jubilee government took over from the previous coalition government. In their manifesto were many promises, among them that of waivering maternity fees in all public health facilities. During the Madaraka day celebrations on June 1, 2013, President Uhuru Kenyatta announced the waiver of maternity charges. The news was received with delight by majority of Kenyans, particularly women. However, some people were not too quick to celebrate as they sought to understand the reality of how that would work without compromising the quality of the services offered in these health institutions.

Probably, to prove the seriousness of the matter, the free maternal healthcare received a boost of over Ksh3.1 billion in the 2013/14 financial year. The National Treasury cabinet secretary, Henry Rotich, made the announcement adding that it had been proposed that the health sector needed about Ksh10.6 billion, with Ksh3.1 billion going towards the free maternal health care, which was a key promise made by the Jubilee Coalition during their campaigns. The move also saw about Ksh522 million allocated for the recruitment of at least 30 community nurses and 10 community health workers in each of the 47 counties.

The decision to waiver maternity fees was guided by the government’s commitment to reduce Kenya’s high maternal death rate. Although many mothers are taking advantage of the new free delivery services, some women still prefer the services of traditional birth attendants for various reasons. For some, it’s because they live a long distance from the nearest health facility and because they do not trust hospitals.

Mary Karendi, 23, who lives in Kayole in Nairobi, delivered a baby boy weighing about 3.5kgs in the hands of a traditional birth attendant who, she says, is very popular, and that most women within her neighbourhood and beyond get assistance from her during delivery.

“I will not disclose the name of my birth attendant but most people in Kayole area know her. She has been helping women deliver their babies for over 15 years and we have never heard of any complications from all the cases she has handled. I chose her because I am not comfortable going to hospital. I understand that some nurses are very rude. Also sometimes there are very long queues as one waits to see the doctor which is not the case with my birth attendant,” she says.

The truth of the matter is that giving birth with the help of a trained professional is critical in reducing maternal mortality, which can simply be defined as the death of a woman while pregnant or within 42 days of termination, from a cause related to the pregnancy or provoked by the pregnancy or its management. It is shocking to know that more than half of Kenyan women still give birth at home without the help of qualified attendants. According to the Kenya Demographic and Health Survey 2008/2009, 56 per cent of women give birth at home. The survey further says that 63 per cent of births in rural areas are delivered at home, compared to 25 per cent in towns.

Some of the reasons given by women for giving birth at home, particularly in the marginalised areas such as the North Eastern region of Kenya, seem valid. They argue that the health facilities are too far from where they live making it almost impossible to access hospital facilities. According to Fatuma Mohamed, who was born in the North Eastern region but currently resides in  Zimmerman in Nairobi; most of the roads in that area are very rough and often impassable by vehicles.

“I gave birth to all my four children at home with the help of a birth attendant before I relocated to Nairobi. The nearest hospital was many kilometres away and there were no vehicles plying our route due to the bad state of infrastructure. Sometimes, I would see women go into labour on their way to hospital and they would deliver on the road side, which I find much riskier than getting a birth attendant who usually lives within the community to come to your house. While I applaud the government for the noble idea of free maternity services, I think they should consider building more health facilities in the arid and semi arid areas of Kenya to encourage the communities living there to seek professional medical attention. Sensitising the communities living in those areas on the need to visit the hospital will also go a long way in encouraging women to deliver in hospitals,” she says.

Mr. Githinji Mwangi from Kiambu County is full of praise for the government for this endeavour. His wife delivered their baby in July and is one of the beneficiaries of the free maternity services.

“I was excited when I heard the announcement that there would be no maternity fee. At first, when the Jubilee party talked of free maternity services during their campaigns, I The government is now encouraging women to give up traditional birth attendants in favour of public hospitals where deliveries are free. Its goal is to reduce Kenya’s high maternal mortality rate.

thought it was a mere ploy to win votes. I was pleasantly surprised when the reality of it sank in after June 1, 2013. I am a casual labourer and providing a meal for my family is a big challenge. My wife is a housewife and we have three other children between the ages of two and seven years.

I was worried about the high maternity fee charged at Kiambu District Hospital where I had hoped my wife would deliver but I’m grateful that when her due date came, she went to the hospital and delivered a healthy baby boy without paying a cent. To me this is a blessing,” an excited Githinji shared.

He nevertheless hopes that the government will employ more doctors and nurses to reduce the congestion being experienced in the maternity wards due to the influx of people seeking the free services. It is, however, not all rosy for some medical personnel who feel stretched beyond the limit. The nurses in public hospitals feel that their workload has greatly increased yet the remuneration is still the same. “The government should hire more nurses and doctors if they want the programme to succeed. Right now, we are overstretched and this can affect the quality of our services. We are working overtime to help mothers deliver since the announcement of the maternity fee waiver,” says a nurse working in a public hospital in Nairobi, who sought anonymity.

“We have many more mothers to help deliver since the maternity waiver was introduced but the number of staff remains the same. Sometimes it becomes impossible to supervise the delivery of all mothers effectively,” she says, further explaining that while she is not against the move, a lot needs to be done to realise this all-important agenda of reducing maternal mortality in the country.

She cites important concerns including mothers being discharged from hospitals prematurely after delivery to create room for others. This makes it difficult to closely monitor and assess the mothers before they leave the hospital as sometimes they are discharged within 24 hours of admission. Another issue of concern is the shortage of mother-baby packs (a take-home box of drugs to prevent mother-to-child transmission of HIV) for HIV positive mothers.

There are also allegations that some public hospitals even have women giving birth on the floor due to lack of enough beds. “It is not enough that expectant mothers are going to public facilities to give birth. We should ensure they are getting quality services. But unless the government does more to improve deliveries in public hospitals, many mothers remain at a high risk due to shortage of staff and critical equipment,” he said.

The government is now encouraging women to give up traditional birth attendants in favour of public hospitals where deliveries are free. Its goal is to reduce Kenya’s high maternal mortality rate. The free maternity policy will credibly enhance the reproductive health status of women by increasing fair access to reproductive health services.

DUE FOR DELIVERY

However, there are many other variables that the government needs to look into, such as proper health care through the public health insurer, the National Health Insurance Fund (NHIF), corruption and inefficiency, which compromise service delivery in public hospitals, as well as sealing all loopholes. For now there is no doubt the move is a step in the right direction.