By Sharonne Namarome

The implementation of the Social Heath Insurance Fund (SHIF) with 2.75 percent deduction is set to begin this month. This program that is designed to replace the National Health Insurance Fund (NHIF) is a significant step in Kenya’s healthcare financing landscape. However, recent policy changes will show that SHIF will only cover free maternal services for indigent mothers alone, a move that threatens to resurge maternal and neonatal deaths that had been reduced under Linda Mama initiative.

The Linda Mama Initiative was established in 2016, and has been central to reducing maternal and neonatal mortality rates in Kenya. According to the Ministry of Health, the maternal mortality ratio in Kenya decreased from 488 deaths per 100,000 lives in 2008 to 342 deaths per 100,000 live births in 2021. Likewise, neonatal mortality deaths decreased 31 deaths 1,000 live births in 2010 to 22 deaths per 1,000 live births in 2021. These improvements are largely attributed to universal access to free maternity services under the Linda Mama program. The initiative ensured that every pregnant woman had access to free healthcare services regardless of their financial status, addressing critical barriers that would have impeded these services such as cost and accessibility. In addition, the initiative was pivotal in increasing access to skilled birth attendants with MOH data indicating that skilled birth attendance had risen from 62 percent in 2014 to 70 percent in 2019, reducing child birth complications, improving the overall maternal and neonatal outcomes. Furthermore, the program improved health-seeking behaviour encouraging more women to seek antenatal care early in their pregnancies. The number of women attending at least four antenatal visits has increased, facilitating early detection and management of potential complications. By restricting free maternity services to only indigent mothers, this policy may lead to surge in maternal and neonatal deaths.

Many mothers who don’t qualify as indigent may forego necessary prenatal ms postnatal care due to financial constraints, amidst the current inflation. This could result in increased birth complications as well as higher mortality rates. Additionally, the administrative burden of determining indigency could delay or deny access to essential healthcare services to many mothers in need. Furthermore, the policy may overburden public health care facilities hindering provision of quality care provided to all patients. It’s no doubt that the program has faced myriad challenges despite it’s centrality in lives of pregnant women. Administrative inefficiencies such bureaucratic delays and lack of proper monitoring has hampered it’s effectiveness. Another challenge funding constraints that delayed reimbursement to healthcare providers and inconsistencies to quality care across different regions, with rural and marginalized areas being the most affected. However, this does not guarantee it to be scrapped off under SHIF. Integrating it thoughtfully into SHIF can enhance its effectiveness and reach, ensuring strides made in maternal and neonatal health are not only preserved but also amplified. Instead of completely scrapping it off, let’s address the real challenges affecting Linda Mama and tailor our approach towards improving them.

First, the MOH should understand that attaining maternity care only comes with prioritizing universal health care services to all women. Secluding them when it comes to access to such essential services will derail our fight against maternal and neonatal deaths.

Secondly, there should be enhanced funding mechanisms to address funding constraints. This can be through dedicated funding for maternity services as well as ensuring timely disbursement of funds to healthcare providers. Having innovative financing models such as public-private partnerships as well as international donor support can also improve funding.

Thirdly, there is a need for standardizing quality care across all regions. SHIF should implement quality control measures to ensure uniform care in all healthcare facilities. This includes upgrading medical equipment, training healthcare workers, and improving healthcare infrastructure, especially in marginalized areas.

Finally, streamlining administration is essential to minimize inefficiencies. To achieve this, SHIF can adopt digital health strategies for monitoring and evaluation. Having an integrated health information system can help track service delivery, financial flows, and patient outcomes on time while at the same time fostering transparency and accountability. Linda Mama is not just a healthcare program, but a lifeline for countless women and their children. Let’s not lose sight of its gains but rather enhance its presence by addressing impending challenges to give every mother and child the best possible start in life.