Supplementary files - the Cost of MNM and PLTCs in Kenya

Reducing
the level of premature maternal deaths (mortality) globally by 2030 to less
than 70 per 100,000 live births is the target of Sustainable Development Goal (SDG)
3.1. Currently, the maternal mortality ratio in Kenya remains relatively high
despite decades of investment and commitments by the government. Moreover,
accurate data to provide the basis for more targeted interventions and to monitor
progress on this particular SDG target are hard to come by. The current study
by APHRC is therefore very timely since it presents national level estimates on the incidence of maternal
near-miss (MNM), the clinical management of pregnancy-related complications and
the direct financial costs of managing such complications. This report
highlights critical gaps in the quality of maternal healthcare to guide
programming towards improving maternal outcomes.

Study
findings show that the national annual incidence of maternal near-miss was
estimated at 7.2 per 1,000 live births and the intra-hospital maternal
mortality ratio was 36.2 per 100,000 live births. Majority of MNM cases were
caused by postpartum hemorrhage and pre-eclampsia. Evidence shows that while
the quality of care was largely optimal, a significant proportion of women
could not obtain the required care for the complications they suffered. Findings
also demonstrated that the direct financial burden of treating near-misses was
high, with wide variations across regions in Kenya. Most patients made out–of-pocket
(OOP) payments for costs incurred during care and a substantial proportion of
patients benefitted from medical fee exemption or waivers.

Based
on these findings, this study offers guidance on strategic opportunities
available at health system, health facility and community levels to address the
gaps identified and strengthen maternal healthcare. These include improving the
health system's capacity to provide care for emergency obstetric care,
introducing facility audits of near-miss events, as well as community-level
research and interventions to eliminate barriers to care and assessing the
efficacy of the free maternal health services policy in Kenya.