Voucher Mothers in Kiambu, Kenya (photo credit: Flynn Warren)

Title: Community-level impact of the reproductive health vouchers programme on service utilization in Kenya

Authors: Francis Obare, Charlotte Warren, Rebecca Njuki, Timothy Abuya, Joseph Sunday, Ian Askew and Ben Bellows

Journal:  Health Policy and Planning

Accepted on January 23, 2012

Published online on April 3, 2012

Abstract:

This paper examines community-level association between exposure to the reproductive health vouchers programme in Kenya and utilization of services. The data are from a household survey conducted among 2527 women (15–49 years) from voucher and comparable non-voucher sites. Analysis entails cross-tabulations with Chi-square tests and significant tests of proportions as well as estimation of multi-level logit models to predict service utilization by exposure to the programme. The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all. There were, however, no significant differences in the timing of first trimester utilization of antenatal care (ANC) and making four or more ANC visits by exposure to the programme. In addition, poor women were significantly less likely to have used safe motherhood services (health facility delivery, skilled delivery care and postnatal care) compared with their non-poor counterparts regardless of exposure to the programme. Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all. The findings suggest that the programme is associated with increased health facility deliveries and skilled delivery care especially among poor women. However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.

Abstract:

German Development Cooperation has a long history of support for reproductive health in Kenya and, in order to achieve progress towards MDG5, the two governments decided on a voucher scheme to improve access to reproductive health care for the country’s most disadvantaged women. Launched in 2006 with funding from the KfW Entwicklungsbank (KfW) the scheme is today jointly funded by the Kenyan Government.

Voucher programmes are part of what is known as ‘output-based aid’ (OBA), a ‘demand-side’ approach to healthcare financing that is attracting growing interest today. The principle behind such programmes is that women below a certain poverty threshold are sold vouchers, at highly subsidised rates, which entitle them to certain specified services at accredited health facilities. On submission of the voucher and an invoice for their services, healthcare providers are reimbursed by the funding agency, and can decide for themselves how to use the income to support services. Unlike with the more traditional ‘supply side’ model of health care financing, where health services are centrally planned and funds are invested in building and maintaining hospitals and clinics, demand side funds are invested in the client.

Kenya’s voucher programme empowers women in that they can choose which facility to attend from a number of accredited institutions, and change providers if they are unhappy with the service. The OBA approach also introduces competition between facilities, giving them an incentive to improve quality in order to attract clients.

Options Consultancy Services, Ltd. has written a Quick Guide to Developing Voucher Programmes.  The Quick Guide to Developing Voucher Programmes provides pull-out sheets on every aspect of setting up and running a voucher programme.

• Claims Processing
• Contracting
• Fraud Control
• Quality Assurance & Accreditation
• Provider Selection
• Management
• Monitoring & Evaluation
• The Role of the Government

The guide was written by Corinne Grainger and Anna Gorter based on their many years of experience with voucher programmes all over the world.