Policy Brief: Basic Maternal and Child Health Continuum of Care in Regional Kenya
Introduction
This policy brief highlights descriptive findings of the maternal and child health (MCH) continuum of health care in rural/semi-rural western Kenya. The African Population and Health Research Center (APHRC) and Amsterdam Institute for Global Health and Development (AIGHD) are undertaking an impact evaluation of the Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program in 24 randomly selected villages of Khwisero Subcounty (Kakamega). According to the 2014 Kenyan Demographic and Health Survey, 96.4% of women in Kakamega obtained antenatal care (ANC) and 47% received facility-based delivery (FBD) services, respectively; 98.4% and 69.5% of women in Kisumu obtained these services. About 35% of women in Western (including Kakamega) and 61% of women in Nyanza (including Kisumu) obtained postnatal services [1].
Approach
This analysis included low-income rural households with either a pregnant woman or a child under four years of age from 32 randomly selected villages. Of these villages, 24 were in Khwisero Sub-county in Kakamega (an expansion area of the i-PUSH program) and 8 in Kisumu to assess the uptake of free health care services as part of Kenya’s Universal Health Coverage (UHC) pilot program.
Ten households per village were selected randomly, forming a total sample size of 246 in Kakamega and 107 in Kisumu. Overall, data on 475 women of reproductive age and 447 children under four years of age were collected from October to November 2019. This study targeted about 340 households with at least one woman of reproductive age (WRA) (18–49 years) who was either an expectant pregnant woman or had at least one child under four years of age.
According to the 2014 Kenyan Demographic and Health Survey, the maternal mortality ratio was 362 per 100,000 live births; mortality rates for infants and those under the age of five were 39 and 52 per 1000 live births, respectively, in Kenya [1]. These figures are attributed to low uptake of basic life-saving health services during pregnancy, childbirth and postpartum. The burden of MCH problems is mostly concentrated in Kenya’s rural and semi-rural areas mainly due to poor health-seeking behaviors and lack of access to basic health services [1, 3].
The Government of Kenya has introduced many low-cost or subsided MCH service schemes including a fee reduction for primary care [4], provision of fee-free services [5], and maternity fee waivers [5, 6] particularly for disadvantaged households within rural, semi-urban and urban slums [6]. More recently, the Universal Health Coverage (UHC) pilot [7- 9] with the aim of achieving a full cost subsidy for essential
