Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation.

摘要: Background Kenya introduced a free maternity policy in 2013 to address the cost barrier associated with accessing maternal health services. We carried out mixed methods process evaluation of examine extent to which had been implemented according design, and positive experiences challenges encountered during implementation. Methods conducted study 3 purposely selected counties Kenya. Data were collected through in-depth interviews (IDIs) policy-makers at national level, managers county frontline staff facility level (n = 60), focus group discussions (FGDs) community representatives 10), facility records, document reviews. analysed data using framework approach. Results Rapid implementation led inadequate stakeholder engagement confusion about policy. While the policy was meant cover antenatal visits, deliveries, post-natal practice only covered deliveries. While rapid increase this not matched by an capacity and hence compromised quality care. The improvement revenues for facilities. However, in all three counties, reimbursements made on time. did have system verifying facility reports utilization Conclusion Kenyan Ministry Health (MoH) should develop formal services, and provide clear guidelines its content arrangements, engage effectively communicate stakeholders, ensure timeliness payment disbursement healthcare facilities, introduce mechanism for reports prepared providers. User fee removal policies such as maternity programmes be accompanied supply side capacity strengthening