Assessing the Effectiveness of Social Health Authority Maternal Health Services on Maternal Health Care in Nyambene Sub-County Hospital, Kenya

Abstract

Background: The Social Health Authority (SHA) was established under the Social Health Insurance Act of 2023 to expand financial protection and improve access to healthcare services in Kenya, including maternal healthcare. However, evidence regarding its effectiveness at the health-facility level remains limited. Objective: This study assessed the effectiveness of SHA-funded maternal health services at Nyambene Sub-County Hospital (NSCH) in Meru County by examining utilisation of antenatal, delivery and postnatal services, trends in maternal morbidity and mortality, and beneficiary satisfaction. Methods: A descriptive cross-sectional survey was conducted among women aged 18–49 years who were registered with SHA and had utilised at least one maternal healthcare service at NSCH. Simple random sampling selected 197 participants; 176 completed the study (response rate 89.3%). Data were collected using a structured questionnaire and a checklist to extract morbidity and mortality information from the Digital Health Information System (DHIS). Data were analysed using SPSS, with descriptive statistics, chi-square tests, Cramer’s V and binary logistic regression. Results: Overall, 91.5% of respondents attended at least one antenatal care (ANC) visit under SHA, although only 23.9% completed more than four visits and 44.9% initiated care in the first trimester. Additionally, 88.1% delivered at NSCH under SHA; 67.1% had normal vaginal deliveries while 23.9% underwent caesarean section. A 12-month review of 2,215 SHA-supported deliveries identified 371 maternal morbidity cases (167.5 per 1,000 deliveries). Anaemia was the leading morbidity (28.6%), followed by urinary tract infections (19.9%), haemorrhage (16.4%) and pre-eclampsia/eclampsia (11.3%). Seven maternal deaths yielded an institutional maternal mortality ratio of approximately 316 per 100,000 live births; postpartum haemorrhage accounted for 71.4% of deaths. Overall beneficiary satisfaction was 71.8%, with skilled birth attendance, confidentiality and affordability rated highly, while labour companionship, emergency waiting times, nursing staff adequacy and facility accessibility received lower ratings. Conclusion: SHA has improved initial access to maternal healthcare but has not ensured complete continuity of care, comprehensive service availability, or adequate reductions in maternal morbidity and mortality. Strengthening early and complete ANC, diagnostic services, emergency obstetric readiness, anaemia prevention, staffing, timely emergency response and respectful, patient-centred maternity care is recommended.