Qualitative Analysis of Free Reproductive and Maternal Health Care and Its Implications for Universal Health Coverage in Kenya

UHC and equity are the dominant goals of any health care system world over. Consequently, the government of Kenya has prioritized the improvement of the reproductive, maternal, child and adolescent health (RMCAH) outcomes. Through ‘Linda Mama’ initiative, the government of Kenya aims to improve access, equity and coverage of RMCAH services funded using tax funds which flow from NHIF directly to the individual healthcare facility's bank accounts. The initiative offers various benefit packages including antenatal care, delivery services, postnatal care, emergency referrals, conditions and complications during pregnancy, and care for the newborns per the national guidelines. In reality, however, the health facilities do not offer some of these services. Additionally, the implementation has exhibited various challenges that impact negatively on the country’s ability to realize the intended objectives. These include high catastrophic health expenditures, low geographical access, bureaucracy in accessing the funds by public facilities, unpredictability, and delays in disbursement of funds. Others include insufficient payment rates, bureaucratic claim process attributed to inadequate training on the process, and poorly developed hardware to lodge claims in the public sector. The achievement of UHC in this regard requires a multi-sectoral approach so that key social determinants of RMCAH such as education, sociocultural factors, nutrition and food security, housing, communication, transport, access to safe water, sanitation and hygiene, are fully addressed.