Benefit Incidence Analysis for Maternal, Newborn and Child Health Services in Kenya

Background: Financing maternal, newborn and child healthcare services is common practice in most countries, and the way such financing is administered rests fundamentally on distributional considerations, that is, on health-sector equity objectives such as equal treatment for equal need. Subsidies should therefore be targeted efficiently to ensure that the poor who need them most, receive them. This study sought to address the questions in public policy strategies, such as, how well public resources are spent on healthcare, to assess if the benefits ultimately reach the poorest segment of the population and whether the public spending on healthcare services is pro-poor. The overall aim of the study was to establish the benefit incidence of the maternal newborn and child health services in Kenya. Methods: The benefit incidence analysis approach employed in this study assessed the benefits of maternal, newborn and child health care subsidies accruing to different socio-economic segments in Kenya. The study drew on the Kenya Demographic and Health Survey (KDHS) 2013/14 and the Kenya National Health Accounts (NHA) 2013/14 to establish the per capita subsidy for maternal, newborn and child healthcare utilization across the population in relation to the wealth index. Concentration indices and concentration curves were used to summarize the distribution of utilization and of the subsidy. Results: The study results indicated income-related inequality in maternal, newborn and child health care utilization in Kenya, and the pattern differed across wealth groups in different geographical areas. The distribution of the total subsidy was pro-poor. However, when the results were expressed as a proportion of total household expenditure, the rich received a subsidy that represented a larger proportion of their expenditure than the subsidy received by the poorest population. Conclusion: Government subsidies for maternal, newborn and child health services in Kenya were pro-poor in absolute terms but were not progressive, and utilization of private and urban facilities was pro-rich. Policymakers should (i) strengthen the targeting of subsidies towards the poorest wealth groups, (ii) reduce the residual out-of-pocket and non-financial barriers facing poor rural households, and (iii) reallocate spending from high-end curative care towards primary-level maternal, newborn and child health services.