Setting: A rural private health facility, Ruby Medical Centre
(RMC), participating in a safe motherhood health
voucher system for poor women in Kiambu County,
Kenya.
Objectives: Between 2007 and 2013, to determine 1)
the number of women who delivered at the RMC, their
characteristics and pregnancy-related outcomes, and 2)
the number of women who received an incomplete antenatal
care (ANC) package and associated factors.
Design: Retrospective cross-sectional study using routine
programme data.
Results: During the study period, 2635 women delivered
at the RMC: 50% were aged 16–24 years, 60% transferred
in from other facilities and 59% started ANC in the
third trimester of pregnancy. Of the 2635 women, 1793
(68%) received an incomplete ANC package: 347 (13%)
missed essential blood tests, 312 (12%) missed the tetanus
toxoid immunisation and 1672 (65%) had fewer
than four visits. Presenting late and starting ANC elsewhere
were associated with an incomplete package. One
pregnancy-related mortality occurred; the stillbirth rate
was 10 per 1000 births.
Conclusion: This first assessment of the health voucher
system in rural Kenya showed problems in ANC quality.
Despite favourable pregnancy-related outcomes, increased
efforts should be made to ensure earlier presentation
of pregnant women, comprehensive ANC, and
more consistent and accurate monitoring of reproductive
indicators and interventions.