Dinah died a very painful death. Sent away by her in-laws while in labour, she walked 10 kilometres through a remote Vihiga County village to her impoverished mother’s house.
Not knowing what to do with her daughter, the elder woman told her to go back. After all, Dinah was now married and she and the baby she was expecting were not her mother’s responsibility anymore. With no help in sight or money to take her to a health facility, Dinah and her unborn baby died on the dusty roadside.
For many years, this sad story has been replicated as thousands of women in die in childbirth in Kenya.
In 2013, a UN report rated Kenya as among the 10 most dangerous countries for pregnant women as 68 per cent of mothers delivered without the assistance of a skilled medical professional. Highlighting the trend of maternal deaths from 1990 to 2013, it indicated that in 2013 alone, 6,300 women had died from pregnancy-related complications. Other reports have given estimates of up to 8,000 similar deaths yearly.
The USAid Kenya-sponsored Health Policy Project gives the reasons for this sad state of affairs.
Dr Isaak Bashir, team leader of the DFID-funded Delivering Increased Family Planning Across Rural Kenya (Difpark) Project at Futures Group, says many women opt to give birth at home because of “lack of transport, fears about negative attitudes of health workers, long distances to health facilities, cultural preferences and, more importantly, charges for services which are beyond what most women can afford”.
On June 1, 2013, President Uhuru Kenyatta launched the Free Maternity Programme, declaring that maternal health services would be offered free of charge in public health facilities. This was aimed at reducing maternal, infant and neonatal mortality and to increase child vaccination.
Public health facilities were reimbursed by the government for every delivery they handled — at Sh2,500 per birth for health centres and dispensaries and Sh5,000 for hospitals. This covered normal, caesarean section and complicated deliveries. The funds were paid directly to the facilities.
In addition, no fees were charged for antenatal and post-natal care up to six weeks after delivery or referrals made in the case of pregnancy-related complications. Fees for all types of healthcare services at dispensaries and health centres were also abolished.
That initiative saw an increase in deliveries in public hospitals. Well over 2,515,051 deliveries have since taken place in public health facilities.
In October 2016, it was handed over to the National Hospital Insurance Fund (NHIF) and rebranded as Linda Mama, which now covers antenatal, neo-natal and post-natal care visits.
Despite being run by the NHIF, the cover remains free. In addition, expectant mothers can be registered using their national identification cards or a guardian’s or even their ante-natal records.
Phase one and two of Linda Mama saw it rolled out to private, faith-based and government-owned facilities. Phase three will offer a comprehensive benefit package to include antenatal, post-natal and immunisation care.
At the launch, the then-Health Cabinet Secretary, Dr Cleopa Mailu, described the programme as part of efforts to enhance system efficiency and accountability and minimise complaints.
“Linda Mama is one intervention that aims to achieve universal access to quality maternal and child health services and contribute to the country’s progress towards universal health coverage,” he said.
So far, 493,475 women have benefited from the cover but, like any new initiative, there are challenges. For instance, a large majority of the population are unaware of the benefits of the cover. The Ministry of Health should, therefore, increase sensitisation, with special focus on the grassroots for better uptake of the services.
County facilities should be equipped with computers and internet services as this is a basic necessity for the Linda Mama cover and, ultimately, the envisaged universal health coverage (UHC) to be realised.
Reimbursement for Linda Mama goes to the county revenue account instead of the county health facilities. This means that the health facilities cannot plough back the funds to enhance their services.
The initiative has proven that the government’s UHC goal is achievable with proper support from the relevant structures.
Though this might have come a little too late for my friend Dinah, her unborn baby and those of us who knew her, it is a timely assurance that, at its full implementation, no other woman will lose her life or that of her baby for lack of medical attention.
Such simple initiatives should be nurtured to maturity with the support of all of us.
Ms Anjalo is a communications practitioner. [email protected] Twitter: @sophlyjess