Effect of health systems strengthening in influencing maternal and neonatal health outcomes in Bungoma County, Kenya.

Introduction: maternal and neonatal health status indicators have steadily improved over time in Kenya. Significant challenges remain, including persistent inequities between population subgroups, and a health system that delivers variable quality care and inconsistent access to care. This paper highlights results of an ex-post evaluation to assess the impact of maternal and health systems strengthening intervention to improve newborn health outcomes in Bungoma County, Kenya, focusing on access to and quality of maternal and neonatal care. Methods: the study design was quasi-experimental, using household surveys to assess outcomes at baseline and end-line. Stratified cluster sampling was used to identify households, based on heath facility catchment areas. Inclusion criteria were women aged 18-49. Chi-square and fisher´s exact tests were used. Patched-up design was used to compare outcomes before and after the intervention and intervention and control sub-counties. Results: provision of transport vouchers decreased barriers to accessto health care, resulting in an increased number of deliveries in health facilities. Women in the end-line group were 95% more likely to deliver at a health facility compared to 74% at baseline. The intervention improved potential and effective access to antenatal care as well as deliveries in health facilities. This positively impacted quality of care provision in the sub-counties. Conclusion: key elements of health system strengthening included reducing cost barriers and enhancing the capacity of the health facilities to deliver high quality care. The intervention addressed commonly identified supply-and demand-side barriers, providing stronger evidence that addressing these hindrances would improve utilization of maternal and child health services.

A comparative analysis of the availability of family planning services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya.

INTRODUCTION: this study assessed the availability of family planning (FP) services in the social franchise and non-franchise private health facilities in Kajiado County, Kenya. Social franchises refer to a standardized delivery model of engaging private health facilities under a common brand name or contractual arrangement. METHODS: this was a facility-based mixed-method approach. Quantitative data was collected through 581 FP client exit interviews and a facility inventory in 32 health facilities. Association between the clients' characteristics and use of FP services was tested using univariable and multivariable logistic regression. Qualitative data were collected through five focus group discussions with FP clients and 16 key informant interviews with service providers and analysed through thematic analysis. RESULTS: the findings show that FP methods availability was the same across all facilities (p = 0.206). The findings were supported by views from the clients who indicated that contraceptives were available. Statistically significant predictors of FP use were found to be women's age group 20-24 years (Adjusted Odds Ratio (AOR) = 2.30, 95% Confidence Interval (CI): 1.12, 4.69) or 25 to 34 years (AOR = 2.10, 95% CI: 1.86, 2.36) versus the 15-19 years and the clients with tertiary level education and above compared primary level education and below (AOR = 0.020, 95% CI: 1.13, 4.41). CONCLUSION: this study demonstrates the need to support all private health facilities with policies and supplies to expand access to all FP services, especially for adolescents.

Does quality matter? An analysis of two-family planning delivery models on quality of care and client satisfaction of services provided in the private sector in Kajiado County, Kenya.

There is evidence that good quality family planning (FP) services increases utilization. This was a facility-based mixed-method to compare the quality of care in the social franchised and non-franchised private health facilities in Kajiado County, Kenya. Quantitative data were collected from 586 FP clients' exit interviews and a facility inventory in 32 health facilities. Additionally, qualitative interviews were conducted with FP users and providers. The outcome variable was client satisfaction. Logistic regression findings show that clients in a social franchise were 2.2 times more satisfied than a non-franchise facility(p=0.03). Social franchises had higher numbers of trained providers on FP (p=0.019) and low contraceptive stock-outs. The satisfied clients had shorter waiting time (p=0.002) and clients with high school education were less likely to be satisfied (Adjusted Odds Ratio = 0.44, p=0.001). Improving contraceptives availability, health provider training and reducing clients' waiting time will increase client satisfaction and thus increase FP use.