Defunding the Linda Mama Programme: A Threat to Women’s Access to Pre and Post Natal Care in Kenya

Abstract

It can be said that it is indeed magical to bring life into the earth. Nonetheless, this remains a daydream for a significant number of mothers, as global statistics estimate a global maternal mortality ratio (MMR) of 223 deaths per 100,000 live births. This falls crucially below the SDGs target of 70 deaths/100,000 live births by 2030. In Kenya, the MMR still falls below the SDGs target, as it stands at 362 deaths/100,000 live births.

Recognising Kenya’s international and constitutional mandate to realise the right to the highest attainable standard of health, Kenya in 2013, initiated a free maternal programme, Linda Mama. Implemented under the National Health and Insurance Fund (NHIF), the scheme ensured that each expectant mother is covered for a period of twelve months after confirmation of pregnancy and is entitled to antenatal care, skilled delivery and postnatal care. This programme was intended to benefit the vulnerable and reduce inequalities in access to pre and postnatal care, eventually reducing Kenya’s MMR. Albeit riddled with various implementation challenges, the number of skilled deliveries continues to rise, and current public health facilities are handling over one million deliveries, translating to a 78.3% increase in accessibility to pre and postnatal care.

The fate of the Programme, however, hangs on a risky balance due to the impending implementation of the new Social Health Insurance Fund (SHIF).  This initiative, part of the current government’s Bottom-Up Economic Agenda, aims to target household contributions rather than the salaried employee contribution in the NHIF. Consequently, the schemes and programmes currently run under the NHIF, including the Linda Mama Programme, have been terminated. Despite assurances promising that pregnant women will be well catered for under the SHIF, the abrupt defunding of the Programme before the roll-out of SHIF poses a great risk to the life of the mother and baby who may be unable to access pre- and post-natal care due to financial constraints.

This paper thus investigates the threat posed to women’s right to access pre and postnatal care amidst the abrupt defunding of the Linda Mama Programme. It argues that the defunding of the programme is a regressive action towards the State’s international and constitutional obligations to fulfil and promote not only the right to women’s access to reproductive healthcare but also the right to life and gender equality commitments. Moreover, the paper argues the shift to the SHIF, albeit with the aim of increasing the base of contribution to the public health insurance scheme, embarks on the use of the Means Testing Instrument (MTI) which fails to consider the financial realities ofwomen in Kenya, especially those from vulnerable and marginalised communities whose access to pre and postnatal care may be inhibited due to inadequate funds. To add, the paper proposes that rather than the abrupt defunding of the programme, the State should find mechanisms of making its access more efficient under the new SHIF programme to ensure that Kenya does not slack in its commitment to achieve the SDGs target of the global MMR.