Difference In Differences Evaluation Of User Fee Exemption For Maternal Delivery In Kenya

Abstract

Globally, deaths due to pregnancy and childbirth dropped from 523,000 in 1990 to 216,000 in 2015. Despite this progress, about 800 still women die every day from complications related to pregnancy and childbirth, an equivalent of 33 deaths per hour. Sub-Saharan Africa remains adversely affected with the region accounting for 62% of these global deaths. Most of these maternal deaths are prevented when attended to by skilled assistants who can identify and refer high risk pregnancies during antenatal care and provide skilled assistance during delivery. However, access to skilled assistance, most of the time found at health facilities, is limited by user fee which deny many women from poor households access to these services. Recent evidence now indicates that abolition of user fee generally leads to an increase in utilization of health services. The government of Kenya renewed its commitment of facilitating progress towards universal coverage by removing user fee thereby providing free delivery in all public health facilities. Using difference-in-difference and data from the Kenya Demographic and Health Survey, 2008-09 and 2014, we assess the impact of user fee removal on the utilization of public and private health facilities for delivery. Our findings confirm an increase in utilization of delivery services in both public and private health facilities particularly in the public sector. In conclusion, we recommend further research to understand unintended effects of an increase in utilization of health services to ensure quality of care is maintained in all health facilities.