The reduction of funding for free maternity services in the National Budget for the 2024/25 Financial Year is raising questions on whether the government is truly committed to the health programme that is designed to eliminate financial barriers to accessing skilled maternity health care, particularly for vulnerable women.
The funding for the free maternal health programme has been reduced by half, from Sh4 billion to Sh2 billion in the national budget estimates for the next financial year which starts on July 1, 2024. As a result, vulnerable women may face unforeseen financial challenges that could result in more unsafe births.
Also, the standard of health care for women might be at risk following the budget cut that will worsen the already poor quality of free maternity services in public health facilities due to inadequate funding.
Most health facilities have inadequate infrastructure, medical equipment, medicines, and supplies, and a shortage of health workers to deliver quality maternity services. This is according to the 2023 'Performance Audit Report on the Implementation of the Linda Mama Programme' by the Auditor General.
An ideal maternity unit should have separate labour wards and maternity rooms, dedicated maternity theatres, laboratory services, adjustable delivery couches, and sufficient delivery kits and beds, the report states.
The audit report reveals that most health facilities wait too long to get paid for the free maternity services they provide under the Linda Mama Programme. This happens because the Ministry of Health delays to send the money for the free maternity programme to the National Health Insurance Fund (now defunct).
Because of the delays in reimbursement of costs, some public health facilities do not have enough money for their daily operations, which makes it hard to give quality maternity services. Also, most county governments are not allocating enough money for community health activities such as awareness creation of the free maternity programme.
The audit report further reveals that due to inadequate funds, the Ministry of Health has not been able to disseminate the free maternity care policy and guidelines to counties. As a result, most county health facilities are not fully aware of the standards and scope of service entitlements under the free maternity programme.
Moreover, the Ministry of Health has not been able to fully execute its function of capacity building and providing technical assistance to counties on maternal health care due to insufficient funds.
The inadequate funding for maternity services unfairly affects poor women who depend on public health facilities. The poor quality of maternity services in most public health facilities also prevents women from seeking care.
The Constitution guarantees every person the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care. The Health Act 2017 further provides that both the national and county governments shall ensure the provision of free and compulsory maternity care, and to implement this, the national government shall, in consultation with county governments, provide funds to counties.
Therefore, the national and county governments need to allocate the necessary funding for maternity services to improve conditions, particularly in public hospitals. There is also a need to adopt and meaningfully implement pro-poor maternal health policies to ensure more women have access to trained health professionals during child birth, which is crucial in lowering the number of maternal deaths.
-Ms Akinyi is an Advocate of the High Court and Programme Officer at International Commission of Jurists Kenya
