OPINION: Kenya’s uncertain path to free maternal health

Kenya is among African countries estimated to have a very high rate of maternal deaths as per the World Health Organization Maternal Mortality Analytical Fact Sheet 2023.

Thousands of women die every year due to pregnancy and childbirth-related complications in the country with the maternal mortality ratio standing at 355 deaths per 100,000 live births annually according to the Kenya Demographic and Health Survey 2022.

The problem of high maternal death persists and is majorly driven by a lack of access to quality and affordable maternal health services.

Over the years, the government of Kenya has been implementing various policy and legal interventions to address the challenge of high maternal deaths in the country.

In 2013, the government introduced free maternity services to assist Kenyans, especially vulnerable populations in accessing maternity care in public health facilities without worrying about costs. This was done to remove financial obstacles for Kenyans seeking medical assistance during pregnancy and childbirth.

In 2016, the government transferred the implementation of the free maternity policy to the National Health Insurance Fund (NHIF), renamed the initiative Linda Mama Programme and expanded the benefit package and access beyond the public sector.

The programme aimed to achieve universal access to maternal health services and contribute to the country’s progress towards universal health coverage but implementation has had its successes and challenges.

Linda Mama led to an increase in accessibility, uptake and community involvement in skilled maternal healthcare.

However, women continue to face financial obstacles when seeking skilled maternal healthcare services.

For instance, expectant women still incur out-of-pocket payments for services not covered by the Linda Mama programme, such as ultrasounds and some medical complications that occur during pregnancy, such as hypertension and malaria.

This is according to a 2022 Performance Audit Report on the Implementation of the Linda Mama Programme by the Auditor General.

The report further reveals that “inefficiencies in the reimbursement of costs incurred by health facilities under Linda Mama programme resulted in significant outstanding balances that affected the flow of revenue to health facilities and hindered efficient delivery of maternity services.”

At present, health facilities have raised concerns over the delay in payment of Linda Mama programme claims.

Some private health facilities have been compelled to stop offering free maternity services under the Linda Mama programme because of a lack of funds.

Additionally, the implementation of free maternal health care policy in Kenya remains uncertain as the government transitions from NHIF to the Social Health Insurance Fund.

The enactment of the Social Health Insurance Fund Act in 2023 repealed the National Health Insurance Fund Act, affecting the free maternal health scheme under the Linda Mama programme.

This notwithstanding, the Health Act provides that the national and county governments shall ensure the provision of free and compulsory maternity care.

“Many women still live at a considerable distance from health facilities, cannot afford to pay fees for maternal services, and face other barriers to accessing quality care.” This is according to “A Comprehensive Assessment Report: Status of Implementation of Free Maternity Services (FMS) Program in the Devolved Health System in Kenya by the Ministry of Health.

Therefore, the Ministry of Health, County Governments, the Social Health Insurance Authority and the National Treasury must take urgent action to ensure the adoption and meaningful implementation of specific policies for free, compulsory, dignified, respectful and quality maternal care.

Christine Akinyi is an Advocate of the High Court and a Programme Officer at ICJ Kenya.