Monitoring Progress in Reproductive Maternal Neonatal Child and Adolescent Health (Rmncah) Following Devolution of Health Services in Kenya: a Trend Analysis

Abstract

Introduction-Universal Health Coverage is viewed as making essential Health Services accessible and affordable to the entire populace such that individuals in the population do not suffer financial wreckage due to health challenges. Although there has been some improvement in Maternal, Child and Adolescent Health in Kenya (the focus of this study), this progress has not met up with the targets set towards achieving Universal Health Coverage. Objective-This study aimed to determine the progress in Reproductive Maternal Neonatal Child and Adolescent Health(RMNCAH) following Devolution of Health services in Kenya. Methodology-This was a mixed study comprising of both quantitative and qualitative study. For the quantitative study, data was collected from the District Health Information System the World Health Organization and the Ministry of Health. Descriptive study was used to explain the proportion of these indicators using Counties has the subjects (i.e. 47). This was carried out using frequency tables, graphs, plots (including time series plot), etc. Changes in the Indicators selected was modeled over time using Repeated measures one-way ANOVA in the 47 counties. RMNCAH index was generated using weighted average for selected indicators. This was then mapped to appreciate the changes over time. For the qualitative study, 3 FGDs and key Informant Interviews were conducted in a National, County and Sub-county facility to understand the knowledge of the women on UHC, services offered and received, differences observed pre and post devolution and finally factors promoting or hindering access to RMNCAH service was determined using a semi-structured interview. R software version 3.3.1, QGIS and SPSS version 13 were utilized to analyze trends. Result- This study shows a decline in the average proportion of women screened for cervical cancer from 2012 to 2018. In this same study period there appears to be an increase in uptake of either long or short acting family planning, proportion of women attending at least 4 ANC visits and a reduction in the proportion of under 1 children immunized, Maternal Mortality Ratio and Neonatal Death. However, proportion of children from 0 to 59 months with severe stunting has increased. Findings revealed a decline in proportion of teenage females aged 15-19yrs pregnant from 2016 to 2018. Conclusion- Comparing 2012 and 2018 data there appears to be some progress in the proportion of women using either short or long-acting family planning methods, reduction in Maternal Mortality Ratio neonatal deaths and teenage pregnancy while there appears to be no progress, rather reduction in the proportion of women that attend at least 4 ANCs, women screened for cervical cancer and proportion of under 5 children severely stunted. These findings were corroborated by the primary data analysis i.e. qualitative study findings.