Free maternal health care still a mirage for Kenya

MUCH to its credit, the Kenyan government has for the past about 10 years tried to put in place measures to achieve at least some of the eight MDGs. However, maternal healthcare still remains a major challenge.

Long before the government passed any policy regarding free maternal healthcare, there was a spirited effort to counter the ever rising maternal deaths through the launch of the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in early November 2010. CARMMA is an African Union (AU) campaign with the theme “Africa cares: No Woman should Die While Giving Life”.

Researchers on the issue say Kenya has strong policies on reproductive and maternal health. The only shortcoming, they observe, is that these policies remain on paper.

It is important that the government establishes a clear plan on how the CARMMA campaign will be used to improve not only maternal but also reproductive healthcare as the two go hand in hand.

Recognising that the MDGs deadline of 2015 was fast approaching, the government in June 2013 adopted a new policy regarding maternal healthcare. The good news was that all public hospitals were now required to give pregnant mothers free maternal healthcare services.

The maternity policy in Kenya has been widely debated with critics arguing that it is not feasible to expect an already ill-resourced public health facility to provide quality free maternal healthcare. Indeed, in many public hospitals there is a dearth of qualified doctors and nurses, with some facilities being run by clinical officers.

Critics say the idea of offering free maternal healthcare in public hospitals is good, and long overdue, but it is poorly implemented. Apart from the Lucy Kibaki referral hospital, the government has not constructed any other facilities nor enhanced (by staffing and equipping) the existing ones to accommodate the anticipated upsurge of expectant mothers, thus further straining the already strained public health facilities.

The result has been the mushrooming of all manner of private maternity clinics, some in very unsavory locations, especially in the small towns scattered around Kenya.

As a result Kenya counts as one of the eight countries in Africa that has made zero progress in reducing maternal deaths.

In fact, maternal mortality seems to be on the rise. The Kenya Demographic and Health Survey shows that maternal mortality has risen from 414 deaths per every 100,000 live births to 488. And according to the White Ribbon Alliance (WRA), 21 women die every day in Kenya because of pregnancy and birth complications that can be prevented through provision of quality healthcare.

Kenya has made little progress in reducing this to achieve the commitment set in the MDGs of 147 deaths per 100,000.

Poor implementation of the hospital fee waiver policy across the country is counter-productive to the goal of reducing maternal mortality rates. Not a day goes by without a media report about mothers being detained in hospitals or denied medical services for being unable to pay medical fees. The mothers also suffer under the hands of unprofessional nurses whose actions sometimes border on criminal activity.

Apart from policy implementation problems, there is an urgent need to address broader healthcare barriers, such as poor allocation of resources and finances. Financial commitment from the national and county budgets would go a long way in achieving overall better functioning health systems.

It does not make sense for an expectant mother to seek medical attention in a government facility where she is required to buy essential medical supplies, such as gloves, razor blades, and surgical thread.

While maternity care is now free, Kenya’s national health budget does not meet the threshold stipulated in the Abuja health commitment of 15 percent made by the AU in 2001. In the current budget only 8.61 percent is allocated to the health sector.

Because of this, maternal health remains neglected, forcing women to give birth without skilled care.

It is inconceivable that successive governments are yet to recognise the importance of having a healthy citizenry. As a matter of urgency, all stakeholders must ensure the government plays its part in providing not only free but quality medical care for mothers in Kenya. –ANA