19 April 2013

Kenya: Will Free Delivery Reduce the High Mortality Rate?

Today as you read this story, 21 mothers will die during delivery. In fact, many more will die in North Eastern region.By the end of the year about 8,000 mothers will have died during labour, three times the number of those who die in road accidents annually which stands at 3,000.

Maternal Mortality now stands at 530 deaths in every 100,000 deliveries, according to the Kenya Demographic Health Survey 2010 report. In North Eastern it is higher at 1,000/100,000.

The deaths are the result of lack of facilities in our public hospitals, lack of qualified personnel and difficulty in accessing health facilities at affordable price.

During this Jubilee year, only 43 per cent of mothers deliver in hospital. In most rural hospitals, babies born prematurely are left to die because they do not have incubators to sustain the fragile life.

"In our hospital, if five children need to use an incubator we have to choose one and leave the others to fight for their lives because we only have one incubator," a doctor at a public hospital told this writer.

The number of babies who die during birth or within 28 days of birth now stands at 28 for every 1000 live births (KDHS 2010). At least 42,000 babies die annually which translates to an average of 115 babies a day as a result of poor quality of healthcare, according to Dr Victor Ng'ani, the chairman of KMPDU, a doctors' association.

The money allocated to healthcare now stands at Sh84 billion which equals 5.9 per cent of the national budget as opposed to the 15per cent envisioned by the Abuja declaration. "Of this amount, about Sh2 billion goes to medicines and medical supplies though we need Sh15.94 billion to cater for proper care," says Dr Ng'ani.


If there is any Jubilee promise that was received with jubilation, it is the promise that our mothers will now deliver free of charge in public hospitals.

The biggest challenge that faces Uhuru's government is not the showing up of women to deliver but to increase the number of qualified personnel and budget to help women deliver safely.

About 1.5 million children are born every year in Kenya. About 63 per cent of mothers currently do not deliver in hospital. According to Dr Ng'ani if we have 100 per cent of the 1.5 million births covered by Kenyatta National Hospital at a cost of between Sh10,000-30,000 per delivery, the government will need about Sh25.5 billion annually to cater for free delivery.

"If we take Pumwani whose maternity fees is lower at sh 4,700-9,000 the government will require about Sh12.5billion to cater for delivery," says Dr Ng'ani.

The above totals assume 100 per cent of all births covered while currently only about 43 per cent of mothers deliver in medical institutions.

"Free delivery addresses only part of the problem. It assumes that most people are already within reach of a facility with sufficient resources to conduct successful deliveries. The truth is that there are very many people who live as much as 80km from the nearest meaningful facility," says Dr Ng'ani.

Most of the public facilities are already overstretched, congested, understaffed, under-equipped and the medicines are not enough.

Free services will increase the number of people competing for these scanty resources resulting in a drop in quality of service as was seen in the free primary education project.

Higher fertility rates amongst adolescents is another challenge the government has to deal with. Although fertility rates have declined in most urban centres, the overall country rate now stands at 4.6 (KDHS 2008-2009).

This means that on average a Kenyan woman give birth to about four children. Unplanned births are still high which means that most women reach delivery date without financial plan. It is these women who are eagerly awaiting Uhuru's promise of free maternity service.

State of Healthcare Data (graphic details)

Budget: Ministry of Health recurrent and development expenditure 2010/2011 Sh29 billion development Sh7b. Total budget for the year Sh60b.

Mortality: Infant mortality stood at 77/1000 in 2003. It dropped to 52/1000 in 2008 and 2009

Under 5 mortality 115/1000 in 2003 dropped to 74/1000 in 2008

Hospitals:Health facilities in 2003 4,557 increased to 8,062 in 2013.

Only 43 per cent of births in Kenya happen in a health facility but in US in 2009, 98.9 percent of births took place in a hospital

Number of doctors: in 2003 stood at 4,800 t2013 we have 7,500 doctors

Doctor patient ratio is 17/100,000 against an ideal of 100/100,000

Ambulance, Most health facilities do not have ambulances to help mothers; some use donkeys

Doctors working abroad 51% of Kenyan health workers now work abroad; they'd likely return with improvement in healthcare industry

Access to Skilled Delivery. Across the five study sites, the majority of births were assisted by skilled health workers (composed of doctor/clinical officer and nurse/midwife teams), ranging from about 75 per cent in Mombasa, Kisumu and Kakamega to 90 per cent in Nairobi. Noticeably the proportion of births delivered by traditional birth attendants remains high in Kisumu, at nearly 15 per cent, and in Mombasa, almost 11 per cent of respondents reported being delivered by a friend or relative.

JUBILEE 12 PROMISEs on healthcare

We will construct 47 county referral hospitals and at least 1,000 model health centres

Achieve free primary healthcare for all Kenyans, starting with women, expectant and breast-feeding mothers and persons with disabilities by increasing health financing from 6% -15%

Increase the number of physical facilities at community level and increasing mobile health clinics services.

Reform the NHIF to uproot corruption and bureaucracy, and to ensure accountability and efficiency.

Guarantee that every family has access to a fully equipped health centre within 5 miles of their home.

Upgrade and equip previous provincial hospitals to referral hospitals, supported by a network of County referral facilities and community level public health centres.

Establish fully-fledged low-cost diagnostic centres and provide adequate screening and treatment facilities for persons with chronic or terminal conditions.

Ensure improved pay packages for doctors and other health practitioners.

Distribute free mosquito nets to all families who need them. Promoting better nutrition by encouraging exclusive breast-feeding, eating traditional foodstuffs and cultivation of kitchen gardens.

Promote medical research, including indigenous medicine.

Promote e-Health as a strategy to reach remote and marginalized areas with health services.

How much does it cost to deliver in a private hospital?( A table will do)


Natural birth

Caesarian section

Aga Khan



Nairobi Hospital




(Clinic charged separately)




40,000 - 45,000

115,000 - 120,000

MP Shah

(Clinic charged separately)



65,000 (with doctor)


Nairobi Women's

32,000 (clinic charged


95,000 (emergency CS)

48,000 (clinic


115 (elective



NHIF Members




Non NHIF members

4,000 (without

drugs or accommodation)

About 8,000 (but

consult for details)

K.N.H (a) General

(Clinic charged separately)



K.N.H (b) Private

(Clinic charged separately)

30,000 - 40,000

80,000 -


Mariakani Cottage

15,000 - 20,000 (clinic charged


75,000-85,000 (clinic charged separately)




40,000 (with



St Johns

6,000 - 7,000



3,000 (without

drugs or accommodation)



NHIF members



WHO data 2009

Total population


Gross national income per capita (PPP international $)


Life expectancy at birth m/f (years)


Probability of dying under five (per 1 000 live births)


Probability of dying between 15 and 60 years m/f (per 1 000 population)


Total expenditure on health per capita (Intl $, 2010)


Total expenditure on health as % of GDP (2010)


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