Table 5. Role of the actors.

	Category of actors	Role in formulation	Role in implementation
Elected officials	The Presidency	Outlining the Jubilee Agenda	Outlining the Jubilee Agenda.
	The members of parliament and senators	No	• Approving the government spending on Linda mama.
	County Governor	No	• Supervision of the CHMT for service provision and financial allocation. • Working in collaboration with other similar projects that are targeted at achieving UHC.
	Member of county assembly	No	• Working with the pregnant mothers who provide feedback about the services received.
Appointed officials/ offices	Office of the Auditor General	No	• Statutory audit of FM policy reports.
	Council of Governors	• Supporting initial technical design (technical capacity) • Modalities of implementation at the county level	• Collaborating with the counties to form council of health ministers from the counties to ensure efficient implementation of the policy at the county level.
	The National Treasury	• Resource and budgetary costing	• Resource and budgetary allocation.
	Cabinet secretary, Principal secretary for health, and Director General (National)	• Oversight of the discussion and direction • Overseeing the implementation of the previous Linda mama Services and transition from the previous FMS to the current Linda Mama	• Providing funds to the NHIF. • Source for funds from the National Treasury and provides strategic, future policy direction in line with the presidential directive of UHC.
	MoH-Department of policy, planning and health Financing (Division of Health Policy and planning and division of healthcare financing) (National)	• Limited involvement except advisory	• Limited involvement. • Advisory on Health financing strategies not linked to Linda mama.
	MoH-Department of preventative and promotive health (Division of Family Health) (National)	• Limited involvement except advisory	• Providing the overall oversight of the implementation of Linda mama (Providing the technical lead on behalf of MoH). • Monitoring and evaluation of the progress of implementation of UHC for which Linda mama is part.
	MoH-Other departments and divisions (Standards and quality assurance and regulations, M and E)	• Limited involvement except advisory	• Limited involvement except advisory.
	County Executive Committee (CEC)–Health	No	• Coordinates health services at the county.
	County Chief officer of health (County)	No	• Hands on in overseeing the implementation of Linda mama at the county level.
	The summit ((CHMT) County directors of Health, Administration and planning and their deputies)	No	• Supervision of the policy outcome. • Providing continuity of supplies and supporting the referral system. • Communication of the policy to the healthcare workers • Employment of the clerks and supervising them.
	The County Treasury (Includes County accountants)	No	• Providing approvals to the facilities to spend the cash. • Accountant oversees financial operations.
	County NHIF focal person	No	• County NHIF point person who streamlining the hospital accounts and making sure they do the right things. • Overseeing the UHC project for which the Linda mama is part. • Linking with the Beyond zero project to ensure free camps maternal camps are carried out.
	Hospital employees (HRIO, NHIF clerk, In charges, Administrators, Other HCWs)	No	• Provide services to the Clients and supporting in their registration.
Purchaser of health services	NHIF (National level)	• Supporting initial technical design (technical capacity) • Came up with ways of improving coverage (issuing cards and setting up offices in the hospital)	• Overall management of Linda mama. • Creating demand and providing awareness / educating the mothers. • Registration of the members and providing the services.
	NHIF (County offices)	No	• Batching of claims form all hospitals in the county.
Member of interest groups	The Church (SUPKEM, Council of churches	• Provide support on the implementation strategy and the duality of it. • Provide input from members	• Educating the congregations on FM policy.
	The Kenya Private Sector Alliance	• Provide support on the implementation strategy and the duality of it. • Provide input from members	• Provide support on the implementation strategy and the duality of it.
	HCWs Unions	• Provide support on the implementation strategy and the duality of it. • Provide input from members	• Critiquing the government’s implementation process.
Donors and development partners	The World Bank	• Funding the initial initiative • Supporting initial technical design (technical capacity) • Part of the technical working group discussing the movement	• Participating in the discussions around health reforms in Kenya for which Linda mama is part.
	WHO	• Supporting initial technical design (technical capacity)	• Evaluate the legal access rights to health care through independent consultants.
	JICA	• Supporting initial technical design (technical capacity)	• Fostering partnerships for UHC.
	UN agencies (UNFPA)	• Advocating for inclusion of a broad spectrum of services	• Supporting the MoH to develop the policy and plans and documents.
	AMREF	(+)	• Engaging the extensive network of community health volunteers and beyond zero to register mothers in the program.
	USAID	• Supporting initial technical design (technical capacity) • Transitioning from the FMS to Linda mama • Supporting the launch of Linda mama through a report	• Directly working with the facilities to enhance the QoC, investing in human resource, investing in supplies and commodities. • Supporting in development of the policies, more so health financing policies. • Working with counties to improve their efficiency in utilisation of the available resources and other resource allocation (PFM act). • Advocacy for increasing resources. • Supporting the District Health Information System (DHIS), and data quality assurance (DQS) in hospitals.
	DANIDA		• Providing equitable fund to improve facilities
	Marie Stopes International	(+)	• Capacity building of the provider level for both private and public providers on claim process, accreditation, process ff contracting. • Demand creation by creating awareness of the policy to the community. • Support the government in achieving UHC.
	Population Service International	• Discussion with the NHIF on the importance of working with the private sector in informal settlements (more so small and middle-level health facilities)	• Through AHME, working with NHIF to package benefit for the informal sector. • Capacity building/ professional competency/ continuous medical education of the providers. • Monitoring and evaluation/ supervision to ensure quality is adhered. • Demand creation by creating awareness of the policy to the community. • Ensuring that the registered facilities are properly licenced by the professional bodies such as NCK, Clinical officers board, KMPDB. • Conduct their own quality checks in the facility before empanelling to ensuring hospitals have beds, referral equipment; and safecare program for 6–12 months before empanelling so accreditation is guaranteed.
Civil society	Kenya National Commission on Human Rights	• A review of implementation of programs including FM policy	• A review of implementation of programs including FM policy.
	KELiN	No	• Providing legal critique of hinging Linda Mama under NHIF.
	Centre for Reproductive Rights	No	• Documenting abuse and disrespect in maternal health setting.
Beneficiaries	Individual citizens (Men and women)	• Involvement of the community in forums and at the launch	• Registering for the service (self-registration or HCW supported). • Benefiting/utilising the services.
	Private health facilities	• Discussion about reimbursement strategies and rates	• Provision of the service to the beneficiaries • Reporting the outcomes.
	Public health facilities	• Providing feedback from the previous FMS	• Provision of the service to the beneficiaries • Reporting the outcomes.
Academia and researchers	Kemri Wellcome Trust	No	• Working with ThinkWell and NHIF to conduct process evaluation of Linda mama.
	Population Council	No	• Impact evaluation of removal of fee for FMP on UHC.
	Mannion Daniels and Options Consultancy	No	• Evaluating a case study of implementing Linda Mama in Kenya Bungoma County.
	ThinkWell	No	• Working with Kemri Wellcome Trust and NHIF to conduct process evaluation of Linda mama.
Media	Local and international media	No	• Participate in media coverage of progress and critiquing the government where there is no progress.
Other	Beyond Zero	No	• Engaging the county governments and the NHIF to do a mobile clinic campaign encouraging mothers to register with NHIF and access Linda mama. • Work with like-minded programs and organisation to support maternal care.
	Jacaranda Health	No	• Coordinating with the healthcare facilities to conduct health care education and training nurses on the care for patients. • Evaluating satisfaction of client on the services provided.
	Philips	No	• Develop innovation and digital solutions for Maternal and Child Health such as Digital labour and delivery solution (DLDS) and Mobile Obstetric Monitoring (MOM).
	CHS	No	• Employing PMTCT nurse in maternity.
	Aphia Plus	No	• Training stuff on provision of quality care; providing equipment and supplies for maternal care.
KEY:	(+): there is participation, but the interviewees could not reveal; (-): there is participation from document review but not outrightly stated;?: In depth interviews and document review could not reveal any evidence of the role Abbreviations: CHS–Centre for Health Solutions; PMTCT–Prevention of mother to child transmission; NHIF–National Health Insurance Fund; UHC–Universal Health Coverage; FMP–Free Maternity Policy; HCW–Healthcare workers

Author, extracted from a review of documents, the IDIs, KIIs, or Exit interviews (Eis) (Note: It is plausible that some actors may have been omitted because they were not apparent in the document reviews or the IDIs, KIIs, or EIs. The EIs here have been discussed in detail else [11]).