title: Healthcare service providers' and facility administrators' perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study.
abstract: BACKGROUND
  Globally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013.
  
  
  METHODS
  A qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis.
  
  
  RESULTS
  Free maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy.
  
  
  CONCLUSIONS
  Free maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.
authors.affiliation: Discipline of Public Health, School of Health Sciences, Faculty of Nursing, Medicine and Health Sciences, Flinders University, SA, Level 2 Health Sciences Building Registry Road Bedford Park, SA, 5042, Flinders, Australia. public.health@flinders.edu.au.|Ministry of Health, Kenya. Kilifi County Government, GPO Box 9-80108, Kilifi, Kenya. public.health@flinders.edu.au.
authors.forename: Evaline
authors.initials: E
authors.lastname: Lang'at
authors.affiliation: Discipline of Public Health, School of Health Sciences, Faculty of Nursing, Medicine and Health Sciences, Flinders University, SA, Level 2 Health Sciences Building Registry Road Bedford Park, SA, 5042, Flinders, Australia. lillian.mwanri@flinders.edu.au.
authors.forename: Lillian
authors.initials: L
authors.lastname: Mwanri
mesh_terms: D036861:Delivery, Obstetric; D004864:Equipment and Supplies; D005260:Female; D058016:Health Facility Administration; D006284:Health Plan Implementation / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D007630:Kenya; D000068097:Maternal Health; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration*; D008428:Maternal Mortality; D010561:Personnel Staffing and Scheduling; D011247:Pregnancy; D011256:Pregnancy Outcome; D000078329:Workforce; D016526:Workload