Medical Doctor with public health experience in the design, implementation, monitoring, and strategic leadership for public health programs in Kenya.
Interested in promoting high impact and sustainable public health interventions through effective health policy formulation, health systems strengthening and research.
Effect of Removal of User Fees on the Utilization of Curative and Preventive Services in Tier II Health Facilities in Maragwa Sub-County, Kenya
On 1st June 2013, the user fees waiver policy was implemented in all public primary health care facilities in Kenya with the aim of increasing the uptake of primary health interventions.
The objective of the study was to assess the effect of the user fees waiver policy on the utilization of primary health care services in tier II health facilities in Maragwa sub –county.
A retrospective longitudinal study design was used to assess the monthly service uptake of preventive and curative interventions in a census sample of 19 tier II health facilities (13 public and 6 private) in Maragwa sub-county over a seven-year period between June 2011 and May 2018. A Mixed-effects Poisson Regression was used to test whether the removal of user fees affected the utilization rates for preventive and curative services in public facilities, and whether the utilization rates differed between the public and private facilities in the period before and after the policy change.
Study findings showed that the policy change did not impact the mean monthly utilization rates of preventive services and there was an overall reduced utilization of curative services in the public facilities. User fees abolition is therefore in itself not adequate to increase, or sustain an increased uptake of primary health services. All aspects of health service delivery need to be addressed to meet the increased demand and sustain an upward trajectory in uptake of primary health services.
Dr. Richard Ayah, MBChB, M.Sc (London), PhD (UoN)
Dr. Marshal M. Mweu, BVetMed (UoN), PGDip (LSHTM), MSc (RVC), PhD (UCPH)