Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya

INTRODUCTION: The Government of Kenya instituted the free maternity services (FMS) policy to improve utilization of maternal healthcare services and thus improve maternal health. The aim of this study was to evaluate the effect of the FMS policy on the uptake of maternal health services in Nyamira County in western Kenya. METHODS: An interrupted time series study design was used to design the study and to analyze the collected data. Forty-two data sets were collected for each outcome variable i.e. 24 pre- and 18 post-intervention. Monthly data was abstracted from the District Health Information System-2 (DHIS-2) and verified using facility data. The collected data was then keyed into SPSS-17, cleaned and analyzed. RESULTS: During the study period, there was a significant increase in births attended by skilled attendants up to the 12(th) month (p<0.05) and caesarean section up to the ninth month (p<0.05). There was a decrease in obstetric complications up to the 12 month (p<0.05). In addition there was a significant increase in institutional maternal mortality ratio (iMMR) in the 12(th) and 18(th) months (p<0.05) following the implementation of free maternity service policy. There was a significant increase in deliveries in hospitals from the 1(st) to the 18(th) month (p<0.05) whereas in primary health care facilities the increase in deliveries was only significant up to the 6(th) month (p<0.05). CONCLUSIONS: The FMS policy led to progress towards improving maternal health by improving access to maternal health services. The improved utilization of maternal health services was more marked in hospitals. There was a worsening of institutional maternal mortality ratio.