1. Facility readiness to provide ANC services in Kenya
Authors: Alfred Agwanda, Ben Jarabi, Andrew Mutuku
Organization: Population Studies and Research Institute, University of Nairobi

2. Outline of presentation
Introduction
Rationale for facility readiness
Research questions
Data & methods
Results
Conclusion
Implications
Next steps

3. Introduction
WHO (2015) - number of women and children who die due to pregnancy related problems have declined but...
830 still die daily - 99% of these occur in DCs such as Kenya
Yet majority of these deaths are preventable through use of ANC (Thaddeus, 1994; Berg et al, 2001; WHO, 2015)
ANC serves as a vehicle for multiple interventions (Ornella et al; 2006)
WHO and GoK recommend at least 4 ANC visits by pregnant women, however ….

4. Introduction cont’d
Only 43% of pregnant women in Kenya make their 1st ANC visit in the 1st trimester (KNBS et al, 2015)
Only 58% of pregnant women make the recommended 4+ ANC visits - an increase from 47% in & 52% in 2003; but lower than 63% in 1993 (KNBS et al, 2015)
Wide regional differentials: Nairobi 73% vs 37% N. Eastern (KNBS et al, 2015)

5. Why focus on facility readiness?
UNGASS 2015, WHO 2015 Global Strategy; Kenya National Strategic Plan focus on:
ensuring accountability in order to improve quality of care and equity
strengthening health systems to respond to the needs and priorities of women and girls
Assessing facility readiness provides benchmarks for strengthening systems for maternal and newborn health care
7/17/2018
FOOTER GOES HERE

6. Research questions
To what extent are facilities ready to provide the requisite ANC services?
How does facility readiness differ by facility type, region, or managing authority?

7. Data and methods Data files: KSPA 2010 facility/provider files
Outcome variable: facility readiness score to provide ANC services (low, medium, high)
Independent variables: facility type (V007); managing authority (V008); region (V001)

8. Data and methods
To compute readiness, the following variables were used:
Staff & service guidelines
Guidelines on ANC (V434A)
Trained staff in ANC (W146)
Equipment
BP apparatus (V433B)
Diagnostics
Haemoglobin test (u345f,g,x); (u346a-e); (V408A)
Urine test for protein (V408D)
Medicines & commodities
Iron tablets (V431Xi)
Folic acid tablets (V431Xj)
TT vaccine (V411A)

9. Analytical method
PCA readiness scores computed & categorised as low, medium, and high
Box plots used to explore differences in facility readiness by facility type, region, and managing authority
Ordered logistic regression used to establish association between facility readiness and facility type, region, and managing authority

10. Results

14. Readiness score by region

15. Multivariate Analysis_ Ordered Logit Regression
Variable OR CI
Region
Central
1.4
(Nairobi=Ref)
Coast
0.6
Eastern
0.4 NE
0.2*
Nyanza
0.5 RV
Western
0.3*

16. Multivariate Analysis cont’d
Variable OR CI
Type
Health center
0.3***
(Hosp=Ref)
Clinic
0.1***
Dispensary
Maternity
0.4* MA
NGO
1.2
(Public=Ref)
Private
1.5
Faith-based
7.9***
Constant cut1
Constant cut2

17. Conclusion
Facility readiness differs by facility type, region and managing authority
Hospitals and HCs are better prepared
Facility readiness best in Nairobi & Central regions - worst in NE
Facilities managed by NGOs have the highest readiness score, with least variation
Public & private facilities have the highest variation

18. Conclusion
Facility readiness differs by facility type, region and managing authority
All other types of facilities are less likely to be ready compared with hospitals
NE & Western regions have the least facilities with a high readiness score compared with Nairobi
Facilities managed by FBOs are x8 more likely to have a high readiness score compared with public facilities

19. Implication
There is inequity in facility readiness by type, region and managing authority
To achieve ANC universal coverage implies revamping facilities by improving their capacity (human & infrastructure), especially in lower level facilities

20. Next steps The team will endeavour to:
Establish general facility readiness
Link facility readiness with client perceptions of services received
Link facility readiness from the 2013 Kenya SARAM report with ANC uptake from the KDHS

21. ASANTE SANA
(THANK YOU)

22. Preliminary results Low Medium High hospital 4.7 31.1 64.2
Type
Low
Medium
High
hospital
4.7
31.1
64.2
health center
16.6
40.5
42.9
Clinic
29.6
37.9
32.5
dispensary
45.8
34.7
19.5
maternity
13.4
36.6
50.1
Kenya
33.8
35.8
30.4

23. Preliminary results Low Medium High Public 41.9 37.8 20.3 NGO 44.9
Type
Low
Medium
High
Public
41.9
37.8
20.3
NGO
44.9
37.9
17.2
Private
28.7
33.4 38
Faith-based
6.5
30.8
62.7