Perceptions of Healthcare Providers on Quality of Services and Their Satisfaction During Implementation of Free Maternity Services Policy in a National Referral Hospital, Kenya
Abstract
In Kenya, the Ministry of Health policies shape healthcare affordability and access. A free maternity policy was announced with executive directives for immediate implementation without considering hospital human resource capacities, processes and financial requirements. Subsequently, the study site experienced a 100% increase in hospital deliveries under constrained human resources, supplies, infrastructure and other resources. Thus, objectives assessed the perceptions of healthcare providers on the quality of services and their satisfaction during the implementation of the free maternity services policy in a national referral hospital, Kenya. Through a cross-sectional design, this survey purposively collected data from 50 doctors and nurses using questionnaires, with quantitative and qualitative aspects, and 20 Key informants, being managers and/or team leaders (till saturation was achieved). Quantitative data was analysed using Stata version 12 to yield frequencies and percentages, and qualitative data was thematically coded and analysed using NVivo version 15. Some opinions have been quoted directly. Findings obtained showed response rate of 50(100%); skills, personal preparedness, deployment, support-supervision (p value 0.05), workload, job satisfaction, capacity to cope with increased patients, availability of various resources, cleaning agents, cleanliness (p value 0.003), and quality of care were rated between excellent-poor. Key informants said, “…the workload is very high. We are doing our best and living one day at a time…access to healthcare has increased…it is not sustainable…with overstretched infrastructure, no supplies…mothers are sharing beds, confidentiality and privacy is remarkably reduced…litigations…complaints may increase...’In conclusion, there was a mismatch between the increased number of clients and the already existing strains in staffing, resources, and infrastructure. Although the majority of healthcare providers faced a myriad of challenges during this period, they identified the capacity to provide quality services and expressed satisfaction.
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LeBlanc ME, Testa C, Waterman PD, Reisner SL, Chen JT, Breedlove ER, et al. Contextualizing response rates during the COVID-19 pandemic: Experiences from a Boston-based community health center study. J Public Health Manag Pract. 2023;29(6):882–91.
Cantarelli P, Vainieri M, Seghieri C. The management of healthcare employees’ job satisfaction: optimization analyses from a series of large-scale surveys. BMC Health Serv Res. 2023;23(1):428.
Orangi S, Kairu A, Malla L, Ondera J, Mbuthia B, Ravishankar N, et al. Impact of free maternity policies in Kenya: an interrupted time-series analysis. BMJ Glob Health. 2021;6(6):e003649.
Saha S, Saha SK, Jha A, Kumar S. Job satisfaction among health-care practitioners: A bibliometric analysis. J Radiol Nurs. 2025;44(1):68–77.
Tama E, Molyneux S, Waweru E, Tsofa B, Chuma J, Barasa E. Examining the implementation of the free maternity services policy in Kenya: A mixed methods process evaluation. Int J Health Policy Manag. 2017;7(7):603–13.
Kainde M, Adela MM. Perinatal outcomes of free maternity services in Mama Lucy Kibaki Hospital, Nairobi County, Kenya. Int J Community Med Public Health. 2020;7(10):3860.
Lang’at E, Mwanri L, Temmerman M. Effects of implementing free maternity service policy in Kenya: an interrupted time series analysis. BMC Health Serv Res. 2019;19(1):495.
Teame K, Debie A, Tullu M. Healthcare leadership effectiveness among managers in Public Health institutions of Addis Ababa, Central Ethiopia: a mixed methods study. BMC Health Serv Res. 2022;22(1):540.
Weaver L, Beebe TJ, Rockwood T. The impact of survey mode on the response rate in a survey of the factors that influence Minnesota physicians’ disclosure practices. BMC Med Res Methodol. 2019;19(1):73.
Memon M, Ting H, Cheah J, Thurasamy R, Chuah F, Cham T. Sample size for survey research: Review and recommendations. J Adv Sci Eng Manag. 2020;4(1):1–10.
Arshabayeva GA, Qumar AB, Yessirkepov M, Zimba O, Kocyigit BF. Advancing research, writing, and publishing in nursing: Addressing challenges and improving standards. J Korean Med Sci. 2024;39(38):e297.
Smythe A, Carter V, Dube A, Cannaby A-M. A better understanding of nursing research roles may help to embed research into clinical structures. Br J Nurs. 2022;31(21):1108–10.
Sy MP, Panotes A, Cho D, Pineda RC, Martin P. A rapid review of the factors that influence service user involvement in interprofessional education, practice, and research. Int J Environ Res Public Health. 2022;19(24):16826.
Chen Y-S, Liao K-C, Yau S-Y. From hesitation to participation: a narrative review of facilitators and barriers for healthcare professionals’ engagement in medical education research. BMC Med Educ. 2025;25(1):302.
Technical Advisory. Augmentation programs towards improved health outcomes [Internet]. Washington (DC): HRH2030 Program; [cited 2025 Jun 9]. Available from: https://hrh2030program.org/wp-content/uploads/2020/08/3.2_HRH2030PH_Deployment-Program-Study-Technical-Advisory.
Cross S, Gon G, Morrison E, Afsana K, Ali SM, Manjang T, et al. An invisible workforce: the neglected role of cleaners in patient safety on maternity units. Glob Health Action. 2019;12(1):1480085.
Rasouli HR, Esfahani AA, Nobakht M, Eskandari M, Mahmoodi S, Goodarzi H, et al. Outcomes of crowding in emergency departments: A systematic review. Arch Acad Emerg Med. 2019;7(1):e52.
Francetic I, Meacock R, Sutton M. Free-for-all: Does crowding impact outcomes because hospital emergency departments do not prioritise effectively? J Health Econ. 2024;95:102881.
Wolfang F, Glaser F, Pruckner G. Hospital crowding and patient outcomes [Internet]. Econstor.eu; 2024. Available from: https://www.econstor.eu/bitstream/10419/308786/1/1914650778.pdf
Butler CR, Webster LB, Diekema DS. Staffing crisis capacity: a different approach to healthcare resource allocation for a different type of scarce resource. J Med Ethics. 2024;50(9):647–9.
Izdebski Z, Kozakiewicz A, Białorudzki M, Dec-Pietrowska J, Mazur J. Occupational burnout in healthcare workers, stress and other symptoms of work overload during the COVID-19 pandemic in Poland. Int J Environ Res Public Health. 2023;20(3):2428.
Murthy VH. Confronting health worker burnout and well-being. N Engl J Med. 2022;387(7):577–9.
Ferguson J, Walshe K. The quality and safety of locum doctors: a narrative review. J R Soc Med. 2019;112(11):462–71.
Weyn T. A fresh outlook: Workforce management with locum tenens. Physician Leadersh J. 2023;10(3):49–51.
Perals PO, Rambaud SC, García JS. Quality of care and patient satisfaction: Future trends and economic implications for the healthcare system. J Econ Surv. 2024 Aug 14; [Epub ahead of print].
Li LZ, Yang P, Singer SJ, Pfeffer J, Mathur MB, Shanafelt T. Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(11):e2443059.
Javernick JA, Dempsey A. Reducing the Primary Cesarean Birth Rate: A Quality Improvement Project. J Midwifery Womens Health. 2017 Jul;62(4):477–83.
Bowden SJ, Dooley W, Hanrahan J, Kanu C, Halder S, Cormack C, et al. Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge. BMJ Open Quality. 2019 Jun;8(2):e000465.
High-value referrals: learning from challenges and opportunities of the COVID-19 pandemic. Concept paper. Copenhagen: WHO Regional Office for Europe; 2023.
Wanja T, Njoroge K, Osoro EN. Factors influencing the upward referral system of patients in Nairobi County. Int J Community Med Public Health. 2021 Sep 27;8(10):4759.
Pyone T, Smith H, van den Broek N. Implementation of the free maternity services policy and its implications for health system governance in Kenya. BMJ Glob Health. 2017 Nov;2(4):e000249.
Acharya J. Are Free Maternity Services Completely Free of Costs? Osong Public Health Res Perspect. 2016 Feb;7(1):26–31.
Oyugi B, Kendall S, Peckham S. Effects of free maternal policies on quality and cost of care and outcomes: An integrative review. Prim Health Care Res Dev. 2021;22:e32.
Copyright (c) 2025 Christine Mwikali Musee, PhD, Judith Mutindi Mweu, Lydia Okutoyi
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