Together with my SF-based research assistant, Matt, we have been outlining case studies of the Uganda and Kenya programs the past two weeks (and working on a report to GPOBA on a baseline survey that Mbarara University ran last November and December — which is where, btw, we ought to be using PDAs/smartphones for data entry… dare to dream.)
These case studies – with more detail than a policy brief and more scope than periodic updates from the implementing partners – will document the range of ideas and actions taken since the programs were launched in 2006 and hopefully be of use in management training sessions, guide others considering voucher programs, and give managers a point of reference when improving these two initiatives in the coming months.
Writing these case studies, I have been re-reading feasibility studies from 2004 and 2005 and have found a few nuggets that ought to be considered going forward. One idea that caught my attention was to reward early attendance at antenatal care with a price cut on the voucher. Although the Kenyan Safe Delivery voucher costs 200 Ksh (~US$2.50, a deal when a facility-based normal delivery can cost 5000 Ksh) it can still be cost prohibitive and non-normative for some poor women unaccustomed to ANC and facility deliveries in their social circles.
I was in Uganda this February as the first Safe Motherhood vouchers were sold and a common concern in the MSI office was that women in their third trimester were buying the vouchers just before delivery. The preventive benefits of ANC visits and the chance to influence pre-natal behaviors were lost. Incentivizing voucher sales among women in their first and second trimester with a lower voucher price addresses behavior and expectations earlier in the pregnancy.
