The effect of free maternal health care services on perceived quality of service delivery at Nakuru Provincial General Hospital

A Dissertation Submitted for a Degree of Master of Business Administration (MBA) in Healthcare ManagementThe introduction of the free maternal healthcare services by the government of Kenya in all public facilities in June 2013 was geared towards addressing the high burden of maternal mortality currently estimated at 488 deaths per 100,000 live births. This is well above MDG target of 147 per 100,000 live births that was to be achieved by September 2015. The increased access to facility based child birth as a result of free maternity services may compromise the quality of maternal care due to inadequate preparations and investments to handle the large influx of expectant mothers. The study aimed at assessing the effect of the free maternal health care at Nakuru Provincial General Hospital which is a teaching and a regional referral hospital serving a catchment population of 1.6 million people. The study was undertaken between August and September 2015. This was a quantitative study employing descriptive research design. Questionnaires were administered after signed consent to the respective post-partum mothers upon discharge from the hospital. Administrative data on measures of quality were used against the National Norm and Standards of Maternal Services in Kenya. A total of 423 post natal mothers participated in the study. The implementation of the free maternal services resulted in a 53% increase in the number of deliveries at Nakuru PGH. Post natal mothers in the age group 20-24 years accounted for the majority 38.5%. Both physical and organizational resources were found to have largely remained the same despite the increased number of pregnant mothers seeking delivery services. However, the healthcare activities (process measures) involved in maternal services were found to be below the minimum National quality standards. In particular, 33.2% of post natal mothers had not signed the medical or surgical consent while 42% of the mothers in labour did not receive the prescribed pain relief medication. However, 97.3% of the post natal mothers had their labour management plotted on partograph. The majority 87% of the post natal mothers had a length of stay of upto two days with 13% of them leaving after one day of admission. The increased number of deliveries at Nakuru PGH as a result of the implementation of the free maternal services had not negatively affected the perceived quality of maternal care. However, more investment in the physical and organizational resources is needed to sustain or improve on the gains made in the quality of care offered. Similar studies are needed in other facilities to come up context-specific recommendations to sustain the free maternity services