NAIROBI, Kenya – A landmark piece of legislation seeking to drastically reduce Kenya's alarming rates of maternal and child mortality is advancing through Parliament, offering a structured legal framework for healthcare rights for mothers and children up to the age of 12. The Maternal, Newborn and Child Health Bill, 2023, which has passed its second reading in the National Assembly, is now a priority item as legislators resume sittings, according to parliamentary records.

The bill, sponsored by Senator Beatrice Ogolla and co-sponsored by the National Assembly's Health Committee, aims to create a coordinated healthcare system focused on reducing mortality and addressing health disparities. If enacted, it will mandate both national and county governments to ensure accessible and quality healthcare, establishing clear roles, funding strategies, and monitoring mechanisms. Key provisions entitle every person seeking these services to be treated with dignity and respect, regardless of socio-economic status.

The Scale of the Crisis

The legislative push comes against a backdrop of grim statistics. Kenya's maternal mortality ratio stands at 355 deaths per 100,000 live births, a figure significantly higher than the Sustainable Development Goal target of 70 per 100,000 live births. According to the Ministry of Health and UNICEF, this translates to over 5,000 women dying annually from preventable causes during pregnancy and childbirth. Between 2020 and 2023 alone, 7,764 women in Kenya died while giving birth.

The leading causes of these deaths are postpartum haemorrhage (excessive bleeding), preeclampsia (high blood pressure during pregnancy), and delays in patient transfers between facilities. A recent Ministry of Health assessment revealed that only four out of ten health facilities in the country are adequately equipped for safe deliveries, highlighting systemic challenges. Neonatal mortality is recorded at 21 deaths per 1,000 live births, while the under-5 mortality rate also remains a significant challenge.

Core Provisions and Intended Impact

The bill seeks to formalize and guarantee a range of essential health services. Its principal object is to establish a comprehensive legal framework that supports quality care for women, infants, and children. This includes outlining specific services for pregnant women, newborns, and children, with special provisions for those with unique needs or disabilities.

A critical component of the bill is the clear demarcation of responsibilities. The national government will be tasked with setting policy and standards, while county governments will be responsible for local implementation and service delivery. Furthermore, the bill proposes the creation of a robust monitoring and evaluation framework to track service quality and identify vulnerable populations, with the Cabinet Secretary for Health having regulatory oversight.

Lessons from Linda Mama

This new legislative effort builds on previous initiatives, most notably the Linda Mama programme. Introduced in 2016 and managed by the then-National Hospital Insurance Fund (NHIF), Linda Mama aimed to provide free maternity services to all Kenyan women. Studies have shown the programme led to an increase in skilled birth attendance and facility-based deliveries.

However, Linda Mama has been plagued by significant implementation challenges. A 2023 performance audit by the Auditor General highlighted that many mothers still incurred out-of-pocket expenses for drugs and supplies. Healthcare facilities have consistently reported severe delays in reimbursements from the government, crippling their daily operations and compromising the quality of care. Furthermore, the programme's benefit package, while expanded on paper, often excluded crucial services like ultrasounds and care for complications in practice. The transition from NHIF to the new Social Health Authority has also created uncertainty around the future of free maternity care.

Funding and Implementation Hurdles

While the bill is a significant step, its ultimate success will depend on overcoming substantial financial and logistical hurdles. The Ministry of Health's own RMNCAH+N Investment Case estimates that Kenya requires Sh460 billion (US$3.54 billion) over the next five years to adequately fund reproductive, maternal, and child health services. The plan projects a growing funding deficit that could reach Sh53.32 billion (US$410 million) by the 2029/30 financial year if new financing mechanisms are not adopted. This is compounded by recent budget cuts, where funding for the free maternal health programme was halved from KSh 4 billion to KSh 2 billion for the 2024/25 financial year, raising concerns about the government's commitment.

Health experts and civil society organisations have cautioned that without guaranteed, timely, and sufficient funding disbursed to county governments, the ambitious goals of the new bill may be unattainable. The capacity of county health systems, chronic staff shortages, and inadequate infrastructure remain critical challenges that legislation alone cannot solve. As the bill moves closer to becoming law, all eyes will be on the national and county governments to see if the political will to pass it is matched by the financial commitment to implement it effectively.