Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation

November 2017
Eric Tama, Sassy Molyneux, Evelyn Waweru, Benjamin Tsofa, Jane Chuma, Edwine Barasa

Kenya introduced a free maternity policy in 2013 to address the cost barrier associated with accessing maternal health services. This mixed methods process evaluation of the policy examines the extent to which the policy had been implemented according to design, and reveals positive experiences and challenges encountered during implementation.

The results of the study revealed that while the policy was meant to cover antenatal visits, deliveries, and post-natal visits, in practice it only covered deliveries. The policy led to a rapid increase in facility deliveries, but this was not matched by an increase in health facility capacity and hence compromised quality of care. The policy led to an improvement in the level of revenues for facilities. However, in all three counties, reimbursements were not made on time. The policy did not have a system of verifying health facility reports on utilisation of services.

The paper provides recommendations for the Kenyan Ministry of Health:

  • Develop a formal policy on the free maternity services.
  • Provide clear guidelines on the policy content and implementation arrangements.
  • Engage with and effectively communicate the policy to stakeholders.
  • Ensure timeliness of payment disbursement to healthcare facilities.
  • Introduce a mechanism for verifying utilisation reports prepared by healthcare providers.
  • Accompany user fee removal policies such as free maternity programmes with supply side capacity strengthening.

RESYST have produced a policy brief based on this paper which highlights both the positive and negative effects of the Free Maternity Services Policy. It outlines the challenges to implementing the policy and suggests how the Ministry of Health can make improvements going forward.

Governance Kenya