肯尼亚实施免费生育服务政策的影响：间断时间序列分析。
BMC Health Services Research
(
IF
2.7
)
Pub Date : 2019-09-06
, DOI:
10.1186/s12913-019-4462-x
Evaline Lang'at
1
,
Lillian Mwanri
2
,
Marleen Temmerman
3
Affiliation
Department of Health, County Government of Kilifi, P. O Box 9-80108, Kilifi, Kenya.
South Australia College of Medicine and Public Health, Flinders University, Flinders University Registry Road, Bedford Park, South Australia, 5042, Australia.
Director at Centre of Excellence in Women and Child Health, Aga Khan University, Aga Khan University Hospital, P.O. Box 30270-00100, Nairobi, Kenya.
背景技术孕产妇和围产期死亡率是全球主要的公共卫生问题，惠阳保姆13825404095在低收入和中等收入国家更是如此。在肯尼亚，每年有超过 6000 名孕产妇死亡和 35,000 名死产。肯尼亚政府于 2013 年 6 月根据免费产妇服务政策在所有公共卫生设施中取消了产妇护理使用费，此举是为了使产妇服务变得可及且负担得起，并降低孕产妇和围产儿死亡率。方法 在肯尼亚 3 个县进行了观察性回顾性研究。每月、政策实施前两年和政策实施后两年观察六项孕产妇健康产出指标。数据是从 3 个县 90 个公共卫生机构的每日产妇登记处收集的，这些机构为估计的 300 万人提供服务。使用单组中断时间序列分析 (ITSA) 来评估政策的效果。使用广义最小二乘 (gls) 模型的标准线性回归来运行六个感兴趣变量中每个变量的结果。使用 gls 模型系数计算绝对和相对变化。结果 政策实施后，产前检查、医疗机构分娩和活产分别显着持续增长89%、97%和98%。在 5 级、4 级和 3 级卫生机构接受紧急产科护理 (EmONC) 服务的妇女也立即显着增加了 27%。政策实施后死产率和剖腹产率没有明显变化。 结论 肯尼亚实施免费产妇服务政策两年后，怀孕和分娩期间熟练护理的使用立即持续增加。研究表明，医院费用是大多数妇女及其家庭在寻求产科护理服务时产生的主要费用，也是利用产科护理的障碍。总体而言，免费产妇服务政策作为一项卫生筹资战略，显示出通过增加获得熟练护理的机会来实现降低孕产妇发病率和死亡率的充分有益效果的潜力。
Effects of implementing free maternity service policy in Kenya: an interrupted time series analysis.
BACKGROUND
Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality.
METHOD
An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre and 2 years post- policy implementation. Data was collected from daily maternity registers in 90 public health facilities across the 3 counties all serving an estimated population of 3 million people. Interrupted Time Series Analysis (ITSA) with a single group was used to assess the effects of the policy. Standard linear regression using generalized least squares (gls) model, was used to run the results for each of the six variables of interest. Absolute and relative changes were calculated using the gls model coefficients.
RESULTS
Significant sustained increase of 89, 97, and 98% was observed in the antenatal care visits, health facility deliveries, and live births respectively, after the policy implementation. An immediate and significant increase of 27% was also noted for those women who received Emergency Obstetric Care (EmONC) services in either the level 5, 4 and 3 health facilities. No significant changes were observed in the stillbirth rate and caesarean section rate following policy implementation.
CONCLUSION
After 2 years of implementing the Free Maternity Service policy in Kenya, immediate and sustained increase in the use of skilled care during pregnancy and childbirth was observed. The study suggest that hospital cost is a major expense incurred by most women and their families whilst seeking maternity care services and a barrier to maternity care utilization. Overall, Free Maternity Service policy, as a health financing strategy, has exhibited the potential of realizing the full beneficial effects of maternal morbidity and mortality reduction by increasing access to skilled care.
