Sunday, 2 June 2013


The president has finally launched the ambitious free maternity services for all Kenyan women. This is a program that needs to be graduated with caution and intense planning because its effects cut across several sectors and affect our sanctity of life

It is estimated that approximately 1.5 million children are born in Kenya every year. Such a program would see to it an end where it would be intended that all these births be conducted in hospitals. Our economic profile only favors that a small proportion would afford private facilities. The rest will deliver in our public institutions.

To better understand the ramifications of this, let me paint to you a picture of our health system as avidly as I can.

The Kenyan health system operates on the concept of cost sharing. Patients are required to pay a much subsidized fee for these services. On their part, the hospitals through their management boards use these funds to keep them running; paying for consumables and employing casuals who are requisite for the running of our health system.

It therefore would be untenable to scrap off this fee without providing an alternative way for the hospitals to survive, they would simply close shop. As a result therefore, the free maternity policy outlines that for every birth conducted, the hospitals would be entitled to a blanket Ksh 5000. As earlier agreed, a majority of the 1.5 million births conducted in Kenya fall in the lower socio-economic quadrant. This is to say that many of them would be anticipated to take up this form of scheme. We are therefore approximating that we would need approximately 7.5 billion Ksh to start off the project.

It cannot be ordered that the money will be reimbursed after services are rendered; the money will be needed to render these services. Where else would the hospitals get the consumables?

Another important aspect to look at would be how often these reimbursements will be made. Making them an annual event would glue our hospitals to year-long debts and in some way incapacitate them. This is likely to affect the quality of services.

While it would be easy to increase the demand for the services through scrapping of the user fee, efforts must be made in the immediate to address the projected increased demand. We still suffer an acute shortage of both nurses and doctors. Increasing the work capacity without adequately addressing this shortfall will definitely injure the quality of health care provision. At present, it would be prudent to employ more nurses and retain the few who were on contract through the economic stimulus program. It would also be far-sighted to increase capacity of both doctors and clinical officers to address the expected surge in demand for these reproductive health services.

While the government allocated just about 2.8% of its GDP to health sector, it is quite obvious that dedicating more than a third of it to just a single sphere of the country’s health strata would have negative end effects on health provision as a whole. More funds need to be channeled to this ministry to better achieve this noble objective.

We also hope that the government will jump over the legal challenge that is the fourth schedule, which clearly stipulates where the mandate of running the affected facilities lie. It is the absolute mandate of county governments to decide the happenings in all public hospitals in Kenya, save for the two referral hospitals.

In the end, we hope for better statistical and substantive result that would pale the dangers of child delivery in Kenya. If that is done, we will surely be many steps ahead of our peers.

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