Local perspectives on policy implementation of free maternity health services in Kenya: Implications for universal health coverage.
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Publication Date
2023-05-02Author
Ombere, O. Stephen
Nyambedha, O. Erick
Haller, Tobias
Merten, Sonja
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Show full item recordAbstract/ Overview
Kenya introduced free maternity services (FMS) in 2013 to enable all pregnant women to give birth for free in all government
public health facilities. Currently, Kenya is rolling out universal health coverage (UHC), which has been acknowledged as a priority
goal for every health system and part of the ‘Big Four Agenda’ for sustainable national development in Kenya. FMS is one of the
core services in Kenya, but since its launch, it is not clear whether the decentralized approach chosen to implement FMS is leading
to UHC. This nine-month ethnographic study in Kilifi County, Kenya, was conducted between March-July 2016 and FebruaryJuly 2017. A narrative approach to analysis was applied. In this article, we interrogate local perceptions of participation during the
crafting and implementation of FMS. Findings show that FMS was detached from local realities, and this was a major inadequacy
of the top to bottom approach. FMS did not consider local power relations and bargaining power which are requisites during policy
formulation and implementation. The participants expressed desire for more localized control over resources from the national
government. The findings suggest that as UHC is rolled out in Kenya, consultation of local stakeholders at the grassroots by the
state departments would likely improve maternal healthcare outcomes. Such consultations must take into consideration differences
in bargaining power and local power relations. Borrowing from the basic tenets of the recent anthropological theorization of
constitutionality, this article proposes a bottom to top approach that leverages and integrates local views during policy-making
process to create trust, a sense of ownership and accountability. (Afr J Reprod Health 2023; 27 [5s]: 71-81).