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      Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities

      research-article
      , ,
      Journal of Environmental and Public Health
      Hindawi

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          Abstract

          Background

          Patients' satisfaction is an individual's positive assessment regarding a distinct dimension of healthcare and the perception about the quality of services offered in that health facility. Patients who are not satisfied with healthcare services in a certain health facility will bypass the facility and are unlikely to seek treatment in that facility.

          Objective

          To determine satisfaction level of mothers with the free maternal services in selected Kenyan public health facilities after the implementation of the free maternal healthcare policy.

          Methods

          Data was collected through a quantitative exit survey questionnaire. The respondents were mothers who had delivered in the health facilities and were waiting to leave the health facilities after discharge. The sample included 2,216 mothers in 77 public health facilities across 14 counties in Kenya under tier 3 and tier 4 categories. The number of respondents to be interviewed was proportionately arrived at based on each health facility's bed capacity.

          Results

          The study established a satisfaction rate of 54.5% among the beneficiaries of the free maternal healthcare services in the country. Mothers benefiting from the free delivery services were satisfied with communication by the healthcare workers, staff availability in the delivery rooms, availability of staff in the wards, and drug and supplies availability (>56%) but unsatisfied with consultation time, cleanliness, and privacy in the wards (<56%). High education levels and lengthy stay in healthcare facilities were negatively associated with the satisfaction with the free delivery services ( P < 0.05).

          Conclusion

          There is a high satisfaction with the free maternal healthcare services in Kenya. However, the implementation of the free maternal healthcare policy was associated with low privacy, poor hygiene, and low consultation time in the health facilities. Therefore there is need to address these service gaps so as to attract more mothers to deliver in public health facilities.

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          Most cited references33

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          Factors influencing place of delivery for women in Kenya: an analysis of the Kenya demographic and health survey, 2008/2009

          Background Maternal mortality in Kenya increased from 380/100000 live births to 530/100000 live births between 1990 and 2008. Skilled assistance during childbirth is central to reducing maternal mortality yet the proportion of deliveries taking place in health facilities where such assistance can reliably be provided has remained below 50% since the early 1990s. We use the 2008/2009 Kenya Demographic and Health Survey data to describe the factors that determine where women deliver in Kenya and to explore reasons given for home delivery. Methods Data on place of delivery, reasons for home delivery, and a range of potential explanatory factors were collected by interviewer-led questionnaire on 3977 women and augmented with distance from the nearest health facility estimated using health facility Global Positioning System (GPS) co-ordinates. Predictors of whether the woman’s most recent delivery was in a health facility were explored in an exploratory risk factor analysis using multiple logistic regression. The main reasons given by the woman for home delivery were also examined. Results Living in urban areas, being wealthy, more educated, using antenatal care services optimally and lower parity strongly predicted where women delivered, and so did region, ethnicity, and type of facilities used. Wealth and rural/urban residence were independently related. The effect of distance from a health facility was not significant after controlling for other variables. Women most commonly cited distance and/or lack of transport as reasons for not delivering in a health facility but over 60% gave other reasons including 20.5% who considered health facility delivery unnecessary, 18% who cited abrupt delivery as the main reason and 11% who cited high cost. Conclusion Physical access to health facilities through distance and/or lack of transport, and economic considerations are important barriers for women to delivering in a health facility in Kenya. Some women do not perceive a need to deliver in a health facility and may value health facility delivery less with subsequent deliveries. Access to appropriate transport for mothers in labour and improving the experiences and outcomes for mothers using health facilities at childbirth augmented by health education may increase uptake of health facility delivery in Kenya.
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            A scoping review of the literature on the abolition of user fees in health care services in Africa.

            In Africa, user fees constitute a financial barrier to access to health services. Increasingly, international aid agencies are supporting countries that abolish such fees. However, African decision-makers want to know if eliminating payment for services is effective and how it can be implemented. For this reason, given the increase in experiences and the repeated requests from decision-makers for current knowledge on this subject, we surveyed the literature. Using the scoping study method, 20 studies were selected and analysed. This survey shows that abolition of user fees had generally positive effects on the utilization of services, but at the same time, it highlights the importance of implementation processes and our considerable lack of knowledge on the matter at this time. We draw lessons from these experiences and suggest avenues for future research.
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              Wealth and antenatal care use: implications for maternal health care utilisation in Ghana

              The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the rural areas and in some of the regions. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for the rural dwellers.
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                Author and article information

                Contributors
                Journal
                J Environ Public Health
                J Environ Public Health
                JEPH
                Journal of Environmental and Public Health
                Hindawi
                1687-9805
                1687-9813
                2018
                22 May 2018
                : 2018
                : 4902864
                Affiliations
                University of Nairobi, Kenya
                Author notes

                Academic Editor: Evelyn O. Talbott

                Author information
                http://orcid.org/0000-0001-9693-7911
                Article
                10.1155/2018/4902864
                5987322
                29951103
                a0f5a7f8-c5e0-460f-a870-2944b66acaa5
                Copyright © 2018 C. M. Gitobu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 October 2017
                : 28 February 2018
                : 17 April 2018
                Funding
                Funded by: African Doctoral Dissertation Research Fellowship
                Funded by: African Population and Health Research Centre
                Funded by: International Development Research Centre
                Categories
                Research Article

                Public health
                Public health

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