Beatrice Mukabana Asule, Arthur Kwena, Theresah Wambui


Introduction: Many countries have come up with various reproductive health interventions with the aim of reducing the maternal mortality. In Kenya, one such key intervention is the introduction of the Free Maternity Care Program whose objective is to increase access and improve utilization of maternity services with the aim of reducing maternal mortality.

Objective: The study sought to determine the effects of Free Maternity Care program (FMC) on utilization of maternity services at Kakamega County Referral Hospital.

Methods: Hospital based cross-sectional descriptive design involving both quantitative and qualitative methods were employed. Two hundred and twenty three (223) post natal mothers selected systematically were interviewed. Desk review of 30% of total patient delivery files was done. Independent T-test and chi-square were used in analysis which was done by use of SPSS version 20. P of <0.05 was considered significant. Qualitative data was analyzed thematically.

Findings:  There was a significant difference in mean number of deliveries between the pre and post free maternity program periods (p=0.001). However, there was no difference in the number of new ANC clients and postnatal attendance (p=0.790 and p=0.449) respectively. Majority of the clients interviewed were satisfied with the services offered.

Conclusion and Recommendations: In conclusion, the Free Maternity Care Program has led to increased utilization of facility deliveries similar to other countries with similar programs. All efforts should be made to sustain the FMC program including the policy makers addressing the challenges. Monitoring and evaluation of the program is essential to foresee its sustainability.


Free Maternity care, program, Utilization of Maternity Services, Client Satisfaction,Maternal Mortality

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Adei, D., Fiscian, Y., Ephraim, L., and Diko S. (2012). Access to Maternal Health Care Services in the Cape Coast Metropolitan Area, Ghana. Current Research Journal of Social Sciences 4(1): 12-20, 2012 ISSN: 2041-3246.

Adhikari, S. R. (2013). An Evaluation of Nepal's Free Health Care Schemes: Evidence from a Quasi-Experimental Design. Available at SSRN 2289344.

Ameyaw, E. A. (2011). An Assessment of the Effect of the Free Maternal Care Policy on the Utilisation of Maternal Care Services in the New Juaben Municipality (Doctoral dissertation, Institute of Distance Learning, Kwame Nkrumah University of Science and Technology, Kumasi).

Asante, F. A., Chikwama, C., Daniels, A., & Armar-Klemesu, M. (2007). Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana. Ghana medical journal, 41(3): 110-117.

Bazant, E. S., & Koenig, M. A. (2009). Women's satisfaction with delivery care in Nairobi's informal settlements. International Journal for Quality in Health Care, 21(2), 79- 86.

Bourbonnais, N. (2013). Implementing Free Maternity Care in Kenya, Challenges, strategies and recommendation – KNCHR

Bosu, W. K., Bell, J., Armar-Klemesu, M., & Tornui, J. (2007). Effect of delivery care user fee exemption policy on institutional maternal deaths in the Central and Volta Regions of Ghana. Ghana medical journal, 41(3): 118-24.

Campbell, J., Oulton, J. A., McPake, B., & Buchan, J. (2011). Increasing access to

‘free’health services: are health workers not a missing link?. International

ournal of clinical practice, 65(1), 12-15.

Chawani, F. S. (2009). Patient satisfaction with nursing care: a meta synthesis (Doctoral Dissertation, Faculty of Health Sciences, University of the Witwatersrand).

Deen, N. (2012). Assessing maternal healthcare in Sierra Leone. The Harvard

Undergraduate Research Journal, 5(2).

Dzakpasu, S., Powell-Jackson, T., & Campbell, O. M. (2014). Impact of user fees on maternal health service utilization and related health outcomes: a systematic review. Health policy and planning, 29(2), 137-150.

Dzakpasu, S., Powell-Jackson, T., and Campbell O.M. (2013). Impact of user fees on policy maternal health service uti lization and related health outcomes: A systematic review. Health and planning; 1-14. Doi:10.1093/heapol/czs 142

Dzakpasu, S., Soremekun, S., Manu, A., ten Asbroek, G., Tawiah, C., Hurt, L., ... & Kirkwood, B. R. (2012). Impact of free delivery care on health facility delivery and insurance coverage in Ghana’s Brong Ahafo region. PLoS ONE 7(11):

e49430. doi:10.1371/journal.pone.0049430

Esena, R. K., & Sappor, M. M. (2013). Factors Associated with the utilization of skilled delivery services in the Ga East Municipality of Ghana Part 2: Barriers to skilled delivery. Int J Sci Tech Res, 2(8), 195-207

Galadanci, H. S., Idris, S. A., Sadauki, H. M., & Yakasai, I. A. (2010). Programs and policies for reducing maternal mortality in Kano State, Nigeria: a review: original research article. African Journal of Reproductive Health: Special Issue 3, 14, 31-36.

Grépin, K. (2009). Free Delivery: The effect of a delivery fee exemption policy on the utilization of maternal health services in Ghana. (Doctoral dissertation, Harvard University).

HERA, Belgium and Health Partners (2012), Evaluation of the free maternal health care initiative in Ghana. Evaluation report by UNICEF.

Ige, O. K., & Nwachukwu, C. C. (2010). Areas of dissatisfaction with primary health care 30, services in government owned health facilities in a semi urban community in Nigeria. Journal of Rural and Tropical Public Health. Age, 30, 30-49.

Kakamega Provincial General Hospital, (2012). Client Satisfaction Survey.

Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2014). Kenya Demographic and Health Survey. Calverton, Maryland: KNBS and ICF Macro

Kaoo, K. (2013). Services available at Kakamega Provincial Hospital

Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2010). Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.

Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2003). Kenya Demographic and Health Survey. Calverton, Maryland: KNBS and ICF Macro

Lerberg, P. M., Sundby, J., Jammeh, A., & Fretheim, A. (2014). Barriers to skilled birth

attendance: a survey among mothers in rural Gambia. African journal of

reproductive health, 18(1), 35-43.

Lagarde, M., & Palmer, N. (2008). The impact of user fees on health service utilization in low-and middle-income countries: how strong is the evidence?. Bulletin of the World Health Organization, 86(11), 839-848C.

Mahamadu, A. H. (2012). Access and utilisation of free maternal health service in the

Savelugu-Nanton district in the Northern region. (Doctoral dissertation,

University of Cape Town)

McPake, B., Witter, S., Ensor, T., Fustukian, S., Newlands, D., Martineau, T., &

Chirwa, Y. (2013). Removing financial barriers to access reproductive,

maternal and newborn health services: the challenges and policy implications for human resources for health. Hum Resour Health, 11(1), 46.

Ministry of Health and Population, New ERA and ICF International, (2012). 2011 Nepal Demographic and Health Survey: Key Findings. Kathmandu, Nepal, and Calverton, Maryland, USA: Ministry of Health and Population, New ERA and ICF International.

Ministry of Health, Health Sector Monitoring & Evaluation Unit, (2015). Status of

program in the devolved health system in kenya. A Comprehensive Assessment

Report. WHO and UKAID

Ministry of Health, (2007). National Reproductive Health Policy. Enhancing Reproductive Health Status for all Kenya. Republic of Kenya.

Mojekwu, J. N., & Ibekwe, U. (2012). Maternal mortality in Nigeria: examination of intervention methods. International Journal of Humanities and Social Science,

(20), 135-149.

Mugenda, O. M. Mugenda, A.G. (2003). Research Methods, Qualitative and Quantitative Approaches.

Muckle, W., Sprague, A., & Fergus, S. (2013). Barriers to access of maternity care in Kenya: a social perspective. J Obstet Gynaecol Can, 35(2), 125-130.

Nketiah-Amponsah, E., & Hiemenz, U. (2009). Determinants of consumer satisfaction of health care in Ghana: does choice of health care provider matter? Global Journal of Health Science, 1(2), p50.

Nyongesa, M. W., Onyango, R., & Kakai, R. (2014). Determinants of clients’ satisfaction with healthcare services at Pumwani Maternity Hospital in Nairobi-Kenya. International Journal of Social and Behavioral Sciences Vol. 2(1), pp. 011-017

Penfold, S., Harrison, E., Bell, J., & Fitzmaurice, A. (2007). Evaluation of the delivery fee exemption policy in Ghana: population estimates of changes in delivery service utilization in two regions. Ghana medical journal, 41(3), 100-109.

Polit, D. F., & Beck, C. T. (2004). Nursing research: Appraising evidence for nursing practice (7th Edition). Philadelphia: Wolters Klower/Lippincott Williams & Wilkins

Reid, N. G., Boore, J. R. P. (1991). Research Method and Statistics in Health care. London;Edward Arnold. ISBN-10: 0340560428.

Republic of the Gambia, (2013). Gambia Demographic Health Survey, Preliminary Report. Calverton, Maryland: Gambia Bureau of statistics ICF Macro. Measure DHS ICF international.

Ridde, V., & Morestin, F. (2011). A scoping review of the literature on the abolition of user fees in health care services in Africa. Health policy and planning, 26(1), 1-11.

Schoenfelder, T., Klewer, J., & Kugler, J. (2011). Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany. International

journal for quality in health care, 23(5), 503-509.

Simkhada, B., Teijlingen, E. R. V., Porter, M., & Simkhada, P. (2008). Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. Journal of advanced nursing, 61(3), 244-260. Doi: 10.1111/j.1365-2648.2007.04532.x

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International journal of medical education, 2, 53-55. DOI: 10.5116/ijme.4dfb.8dfd

Unicef. (2014). Trends in maternal mortality: 1990 to 2013. Estimates by WHO,UNICE, UNFPA, The World Bank and The United Nations Population

Wang, W., Alva, S., Wang, S., & Fort, A. (2011). Levels and trends in the use of maternal health services in developing countries. DHS Comparative Reports No. 26. Calverton, Maryland, USA: ICF Macro

Witter, S., Dieng, T., Mbengue, D., Moreira, I., & De Brouwere, V. (2010). The national free delivery and caesarean policy in Senegal: evaluating process and outcomes. Health Policy and Planning, 25(5), 384-392.

Witter, S., Adjei, S., Armar-Klemesu, M., & Graham, W. (2009). "Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana", Global Health Action, vol. 2.

Witter, S., Arhinful, D. K., Kusi, A., & Zakariah-Akoto, S. (2007). The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Reproductive health matters, 15(30), 61-71.

World Health Organization, (2008). Factsheet: Millennium Development Goal 5. World Health Organization


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