Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage

Background: The strategic aim of universal health coverage (UHC) is to ensure that everyone can use health services they need without risk of financial hardship. Linda Mama (Taking care of the mother) initiative focuses on the most vulnerable women, newborns and infants in offering free health services. Financial risk protection is one element in the package of measures that provides overall social protection, as well as protection against severe financial difficulties in the event of pregnancy, childbirth, neonatal and perinatal health care for mothers and their children. Purpose: The aim of this study was to find out the extent of awareness, and involvement among managers, service providers and consumers of Linda mama supported services and benefits of the initiative from the perspectives of consumers, providers and managers. Methods: We carried out cross sectional study in four sub counties in western Kenya: Rachuonyo East, Nyando, Nyakach, and Alego Usonga. We used qualitative techniques to collect data from purposively selected Linda Mama project implementors, managers, service providers and service consumers. We used key informant interview guides to collect data from a total of thirty six managers, nine from each Sub -County and focus group discussion tools to collect data from sixteen groups of service consumers attending either antenatal or post-natal clinics, four from each sub county, selecting two groups from antenatal and two from postnatal clinics in each sub county. Data analysis was based on thematic content analysis. Findings: Managers and service providers were well aware of the initiative and were involved in it. Participation in Linda Mama, either in providing or using, seemed to be more prominent among managers and service providers. Routine household visits by community health volunteers to sensitize mothers and community engagement was core to the initiative. The managers and providers of services displayed profound awareness of how requiring identification cards and telephone numbers had the potential to undermine equity by excluding those in greater need of care such as under-age pregnant adolescents. Maternity and mother child health services improved as a result of the funds received by health facilities. Linda Mama reimbursements helped to purchase drug and reduced workload in the facility by hiring extra hands. Conclusion: The initiative seems to have influenced attitudes on health facility delivery through: Partnership among key stakeholders and highlighting the need for enhanced partnership with the communities. It enhanced the capacity of health facilities to deliver high quality comprehensive, essential care package and easing economic burden

UPTAKE OF TASK SHIFTING AS A COMMUNITY STRATEGY IN KENYA

The objective of the study was to evaluate the uptake of task shifting as a community strategy in Kenya. This study adopted qualitative data collection methods in three different contexts; peri-urban, rural and arid Kenya. The results suggest that voluntary counselling and testing, community health education, hygiene, referrals and family planning services should be shifted to Community Health Workers (CHWs) and they should be trained to diagnose and treat some common childhood ailment. There is evidence that CHWs perform an important role in helping to achieve the Millennium Development Goals (MDGs) for health, particularly for child survival and treatment of TB and HIV/AIDS. Effective task shifting requires appropriate utilization of primary health care services, effective training and incentives for health workers to provide services

DETERMINANTS DE LA SOUS-ALIMENTATION DES MENAGES EN CÔTE D’IVOIRE : CAS DES REGIONS CENTRE ET CENTRE-EST

Undernutrition is one of the major issues in the development agenda; the increase in food prices in recent years increases the vulnerability of households and climate change has adverse impacts on agricultural production.The objective of this study is to identify the determinants of undernutrition households in the Central and East-Central Côte d'Ivoire, ranked among the most deprived areas. Using data from the Survey of Household Living Standards (ENV 2002), Logit econometric models revealed that among these factors include household size, gender of household head, education level of the head household, the main occupation of the household head, the industry, living environment and the practice of farming. This analysis shows that the undernourished households are characterized in particular by high size, low level of education, the exercise of the profession of craftsman in the informal sector and are mostly headed by women. These determinants are levers that authorities may rely to reduce undernutrition. Therefore, it is desirable for the government to popularize family planning (reduction in household size), raising the level of education of the population at least at the secondary level, to promote the profession of craftsman by the capacity building and stakeholder access to microfinance to combat undernutrition

UPTAKE OF COMMUNITY HEALTH STRATEGY ON SERVICE DELIVERY AND UTILIZATION IN KENYA

Great Lakes University of Kisumu developed and tested a Comprehensive Primary Health Care (CPHC) model to facilitate the uptake of essential health services towards Millennium Development Goals (MDGs). The model focused specifically on the principles of intersectoral collaboration, community participation and empowerment to enhance access to health care. A study was undertaken in partnership with the Ministry of Health (MOH) to assess the implementation of the components of the model in different socio-demographic contexts in Kenya, and their relationship with health outcomes. This was a comparative, descriptive study which engaged the end users, policymakers, managers and communities in the design and implementation of research to enhance the utilisation of results. The CPHC intervention elements included: establishment of Community Health Units, governance and linkage structures, training of the health workforce, establishment of Community Based Information system and using it for regular dialogue at community and health facility levels leading to decisions and health actions.Findings showed improvements in governance and management of the health system; service delivery and health outcomes such as immunization coverage, Antenatal Clinic attendance and health facility delivery

Improvement of health outcomes through the contribution of entrepreneurial theories in Kenyan communities

Community Health Workers play an important role in the community strategy program in Kenya. They drive the crucial role of broadening access and coverage of health services in remote areas and undertake actions that lead to improved health outcomes. However, a lot of concentration on improvement of health outcome through this cadre of health workers has been purely a human health science issue and the progress of the process has been a bit slow. On the other hand, Community Health Workers potentials have also not been fully utilized due to their low economic status. Studies have shown the importance of having forces pushing the background factors to influence health outcomes. The one possible force is the driver influencing the socio-economic factors. The aim of the study is to inject an entrepreneurial model into the existing health model to drive the socio-economic aspect in the hope of improving the Community Health Workers economic status and the community health outcomes

An integrated rural health project in Saradidi, Kenya

In 1979 a community self help health development programme was initiated in Saradidi, Kenya, as the community's response to its problems. In line with the theoretical considerations made for the implementation of primary health care the community was involved in planning, organization, setting of priorities and objectives, implementation and evaluation of the programme. The Saradidi Health Development Project (SHDP) was initiated by people from the area with material assistance from within and outside Saradidi. Nearly 10 years since the beginning of the project, the SHDP still runs more or less on its own providing experiences for other projects and initiators.primary health care Kenya rural health programmes

Motivational drivers for non-skilled Kenyan community health volunteers

Community based health volunteerism view skilled and non-skilled health volunteers as making significant contributions towards improved healthcare for mankind. They are a 'workforce' that has made significant efforts towards delivery of health services at the community level. A cross-sectional and descriptive study was carried out in Nyanza Province of Kenya. Mixed research methods were utilized to derive datum from 261 respondents. Four sampling methods were employed to select the respondents. Variables were selected and subjected to chi square testing to determine their level of significance. The largest proportion of volunteers were providing services in areas of maternal and child health followed by HIV/AIDS and malaria. Drivers that motivate volunteers to keep on providing free services include in-born leadership qualities, fulfilling religious values and serving humanity. Access to incentives such as training, supervision and follow through the support services from various agencies was reported