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Examining the quality of care across the continuum of maternal care (antenatal, perinatal, and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study

Oyugi, Boniface and Audi-Poquillon, Zilper (2024) Examining the quality of care across the continuum of maternal care (antenatal, perinatal, and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study. BMJ Open. ISSN 2044-6055 (In Press)

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Abstract

Background Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address the challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. Methods We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews (KIIs) with national stakeholders (n=15), in-depth interviews (IDIs) with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (FGDs) (n=9) with mothers who returned for postnatal visits (at 6, 10, and 14 weeks). Quantitative data was analysed descriptively, while qualitative data was analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for Maternal and Newborns. Results The results showed that the expanded FMP enhanced maternal care access: geographical, financial, and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care (ANC) package of the LMP. The availability and standards of equipment, supplies, and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal, and emotional abuse and a lack of attention/care. Conclusions Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the UHC goals through better quality service for every woman.

Item Type: Article
Additional Information: © 2024 The Author
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 18 Apr 2024 11:18
Last Modified: 16 May 2024 04:22
URI: http://eprints.lse.ac.uk/id/eprint/122656

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