Evaluating the Impact of Maternal Care Facility Systems on Clinical Outcomes in Kenya: A Quasi-Experimental Intervention Study

"background": "Maternal mortality remains a critical public health challenge in sub-Saharan Africa. Systemic weaknesses in care delivery at health facilities are a recognised contributor to adverse outcomes, yet robust evidence on the causal impact of facility-level systems interventions is limited. ", "purpose and objectives": "This study aimed to quantify the causal effect of a structured maternal care facility systems intervention on key clinical outcomes. The primary objective was to estimate its impact on the rate of postpartum haemorrhage (PPH). ", "methodology": "A quasi-experimental, difference-in-differences design was employed across 42 public health facilities. The intervention comprised a bundled package of systems strengthening: standardised clinical protocols, emergency equipment provisioning, and team-based simulation training. Control facilities continued routine care. The primary outcome was the facility-level PPH rate, analysed using a generalised linear mixed model: \ (EY{it) = \0 + \1 (\) + \ Xit + \ + \ +, where \ and \ₜ are facility and time fixed effects. Robust standard errors were clustered at facility level. ", "findings": "The intervention was associated with a statistically significant reduction in the PPH rate. The adjusted incidence rate ratio was 0. 72 (95% CI: 0. 58 to 0. 89), corresponding to a 28% relative reduction. Secondary analyses indicated improvements in adherence to clinical guidelines and availability of essential commodities. ", "conclusion": "A targeted facility systems intervention significantly improved a critical clinical outcome. This provides causal evidence that strengthening operational systems within existing health infrastructure can enhance maternal care quality. ", "recommendations": "Policy should prioritise integrated, facility-level systems strengthening bundles. Programme design should incorporate rigorous embedded evaluation to quantify health impacts and inform scale-up. ", "key words": "maternal health, health systems