Relief for mothers as state moves to ease delivery restrictions at lower-tier hospitals

The Government is considering easing childbirth restrictions at lower-tier health facilities and may soon permit emergency deliveries to take place at Level 2 and Level 3 hospitals.

However, the Ministry of Health must first issue an administrative directive allowing these facilities to handle emergency births, reversing an earlier policy that restricted deliveries to Level 4 hospitals and above.

Director-General of Health, Dr Patrick Amoth, told the National Assembly’s Committee on Health that guidance has already been issued to the Kenya Health Professionals and Digital Council (KHPDC) and the Digital Health Agency, recognising Level 2 and Level 3 facilities as eligible for emergency delivery reimbursements.

“This means the facilities will now qualify for government compensation when managing emergency maternal cases,” he explained.

The Committee will review the Ministry’s proposal once a detailed financial and legal justification is submitted, paving the way for potential amendments to allow lower-level facilities to provide maternity services under the Primary Healthcare (PHC) package.

“The issues raised by Members are very pertinent and align with concerns identified through the Kenya Health Information System, particularly regarding deliveries and other services. Consequently, I advised the Cabinet Secretary to authorise Level 2 and Level 3 facilities to have delivery beds for emergency purposes,” Dr Amoth said.

Dr Amoth noted that Health Cabinet Secretary Aden Duale has issued formal letters to the CEOs of KHPDC, the Digital Health Agency, and the Social Health Authority (SHA) to implement the directive, and corrective measures have been taken to address service delivery gaps at these facilities.

His remarks responded to concerns raised by Nandi Women Representative Cynthia Muge, who cited cases where Level 2 and 3 facilities performing maternity services were recorded as having zero beds by KHPDC, leading to rejected reimbursement claims despite handling dozens of deliveries monthly.

For instance, one health centre in Trans Nzoia recorded 74 deliveries between July and September, yet claims were rejected because the system classified it as a “zero-bed” facility, while another recorded 46 deliveries with no reimbursement. “These are real mothers delivering in public facilities, yet because the system says they have no beds, they are not reimbursed. This is unacceptable and must be fixed urgently,” Ms Muge said.

Duale acknowledged the concerns, noting that lower-tier facilities are often the only practical option for expectant mothers in remote areas. “Some Level 2 and Level 3 facilities, particularly in remote villages, are the only accessible option for mothers in labor. Once a mother goes into labor, she cannot travel long distances to the nearest Level 4 hospital,” he said.

He added that the Ministry is engaging the regulator to ensure this is done properly without duplicating agency mandates.

Seme MP Dr. James Nyikal questioned the rationale behind restricting deliveries to higher-tier facilities, noting that women have historically delivered at Level 2 and 3 hospitals. “If there are legal provisions that are prohibitive, then our team must address them. Amending the law may not be immediate, but it is necessary,” he said.

The CS explained that while legal amendments are being pursued, immediate administrative action is underway, guided by the Director-General.

The directive is expected to ease pressure on higher-level hospitals, reduce referral delays, and improve timely access to maternal care, especially in rural and underserved areas where the nearest Level 4 facility may be far away.

However, expanding the full PHC package to permanently include maternity services at Level 2 and 3 facilities would require significant financial resources. Dr. Amoth noted that legal amendments recognising these services could cost an additional Sh4.9 billion annually.

Nyeri Town MP Duncan Mathenge suggested additional funding may not be needed, as the Social Health Insurance Fund (SHIF) already provides a maternity package. “The key is to align benefits so that the maternity package under SHIF extends to lower-level facilities,” he said.

CS Duale countered that legal amendments are essential, as Parliament has established three distinct funds under the SHA Act—SHIF, the Primary Healthcare Fund, and the Emergency, Chronic, and Critical Illness Fund (ECCIF). “The only sustainable solution is to amend the law to formally recognize maternity services at lower-tier facilities,” he said.

Endebess MP Dr. Robert Pukose emphasized that expecting mothers in rural areas cannot be forced to reach higher-tier hospitals, and emergency deliveries at Level 2 and 3 facilities are often unavoidable.

“When a mother goes into labor, she seeks help at the nearest health facility. She may arrive in second-stage labor, and that facility must be able to provide emergency delivery services to save lives,” he said. Dr. Pukose acknowledged that many facilities operate with limited staff, sometimes only one nurse, but noted that even this staff can assist with emergency deliveries and save lives.