Health System Redesign to Shift to Hospital Delivery for Maternal and Newborn Survival: Feasibility Assessment in Kakamega County, Kenya

Kojo Nimako; Anna Gage; Caroline Benski; Sanam Roder-DeWan; Khatra Ali; Charles Kandie; Aisha Mohamed; Hellen Odeny; Micky Oloo; John Tolo Boston Otieno; Maximilla Wanzala; Rachel Okumu; Margaret E. Kruk

doi:10.9745/GHSP-D-20-00684

Key Findings

Maternal and newborn health service delivery redesign (MNH redesign) is a policy to shift all deliveries to or close to hospitals.
Current system assets that support MNH redesign in Kakamega County are the adequate geographic spread of hospitals, close proximity of women to these hospitals, and high provider and user support for the concept.
Before MNH redesign is implemented in Kakamega County, prevailing health system deficits, like health provider shortages and transportation challenges for mothers, would need to be addressed.

Key Implications

The county, in partnership with health system researchers, should rigorously evaluate the process of implementing MNH redesign and its impact on health, to learn and test the model and to serve as a base for generalizing uptake across the country.
Countries that seek to implement MNH redesign would need to similarly assess feasibility to determine the assets and gaps for implementation.

ABSTRACT

Maternal and newborn health (MNH) service delivery redesign aims to improve maternal and newborn survival by shifting deliveries from poorly equipped primary care facilities to adequately prepared designated delivery hospitals. We assess the feasibility of such a model in Kakamega County, Kenya, by determining the capacity of hospitals to provide services under the redesigned model and the acceptability of the concept to providers and users. We find many existing system assets to implement redesign, including political will to improve MNH outcomes, a strong base of support among providers and users, and a good geographic spread of facilities to support implementation. There are nonetheless health workforce gaps, infrastructure deficits, and transportation challenges that would need to be addressed ahead of policy rollout. Implementing MNH redesign would require careful planning to limit unintended consequences and rigorous evaluation to assess impact and inform scale-up.

Received: October 23, 2020.
Accepted: September 22, 2021.
Published: December 31, 2021.

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