Sharma, J., Leslie, H.H., Kundu, F. and Kruk, M.E., 2017. Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya. PloS One, 12(1), p.e0171236.
We investigated the distributional aspects of quality of maternal healthcare, an important determinant of future progress in global health, but one that has received inadequate attention. We mapped the quality of maternal care in facilities located in poorer versus wealthier areas of Kenya, and compared the quality of maternal care available to Kenyans in and not in poverty.
Our results indicated a low quality of maternal care in Kenya. Clinical quality of antenatal and delivery care was worse than structural inputs to care. In addition, we also found that maternal health care quality varied significantly with poverty level; our measures for maternal care quality were lowest for facilities in the most impoverished areas and increased with increasing wealth. More importantly, population access to a minimum standard (at least 0.75 of 1.00) of quality maternal care was both low and inequitable: only 17% of all women and 8% of impoverished women had access to minimally adequate delivery care, and effective ANC coverage to 9%.
Our evidence adds credence to suggestions that ineffective health care coverage is common in sub-Saharan Africa and a probable driver to poor health outcomes despite increased coverage.