Community experiences and perceptions of reproductive health vouchers in Kenya

Abstract

BackgroundResearch on demand-side health care financing approaches such as output-based aid (OBA) programs have focused on evaluating the role of the programs improving such outcomes as utilization of services and quality of services with limited focus on the experiences and perceptions of the target communities. This paper examines community members’ views of the output-based aid voucher program in Kenya.MethodsA household survey was conducted in 2010 among 1,336 women aged 15-49 years living in the catchment areas of contracted health facilities in three districts participating in the voucher program (Kisumu, Kiambu and Kitui). Twenty seven focus group discussions were conducted with voucher users, non-users, opinion leaders and voucher distributors in the three districts as well as in Nairobi. Analysis of the quantitative data involved frequency distributions and cross-tabulations. Qualitative data were transcribed and analyzed by adopting framework analysis and further triangulation of themes across respondents.ResultsMajority (84%) of survey respondents had heard about the safe motherhood voucher compared to 24% and 1% that had heard about the family planning and gender-based violence recovery services (GBVRS) vouchers respectively. Similarly, 20% of the respondents had used the safe motherhood voucher compared to 2% for family planning and none for the GBVRS vouchers. From the community members’ perspectives, the voucher program is associated with improvements in access to health services for poor women, improved quality of care, and empowerment of women to make health care decisions. However, community members cited difficulties in accessing some accredited health facilities, limitations with the system of selling vouchers, lack of male involvement in women’s reproductive health issues, and poor understanding of the benefits associated with purchasing the voucher.ConclusionThe findings of this paper showed that the voucher program in Kenya is viewed by the community members as a feasible system for increasing service utilization, improving quality of care, and reducing financial barriers to accessing reproductive health services. However, the techniques of program execution such as proper information and availability of the distributors as well as local attitudes influence whether vouchers are purchased and used.

Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya

“…Population Council research has also found that negative attitudes of nursing staff and absence of medical personnel at facilities act as barriers to women receiving timely care and attention from SBA [9]. Another recent study in Kenya found that D&A of women during and immediately after childbirth discourages women from attending facility-based births and reported that traditional birth attendants (TBAs) accord them more respect [10]. This was reiterated in the focus group discussions with women in the Kenya Service Provisions assessment 2009/2010 [11].…”

“…The advantages of linking this present study with the voucher research in Kenya include the following; (i) Recent data from population surveys across the three districts in Kenya implementing the voucher program and three control districts indicate that disrespect and abuse of women during childbirth and immediately after is hindering the program in achieving its goal of increasing the number of facility-based births, compared to voucher control sites the voucher is protective of women from disrespect and abuse [10]. The wealth of information on D&A being gathered through the voucher evaluation provides a solid foundation from which to develop quantitative measures and test interventions to reduce disrespect and abuse.…”

Stakeholder perspectives regarding transfer of free maternity services to National Health Insurance Fund in Kenya: Implications for universal health coverage

“…The larger study used a pretest and posttest design with a comparison group. Preintervention (pre‐FMS policy) data were from a 2012 study that evaluated the effect of the reproductive health vouchers program in Kenya on health outcomes by comparing communities in voucher and comparable nonvoucher sites . The postintervention data were collected in the same communities included in the 2012 study and involved both quantitative and qualitative components.…”

“…Following the pilot, the program was expanded to one additional county (Kilifi) as well as to additional facilities in the pilot counties, and implementation continued until late 2016. The results of this initiative indicated promising opportunities for improving access, coverage, and quality for targeted low‐income beneficiaries …”

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya

“…For example; researchers have assessed the population level impact of vouchers on health facility delivery [15] and evaluated the community level impact of vouchers service utilization which showed that the voucher scheme helped in reducing the proportion of women in the community who paid out-of- pocket for safe motherhood services [16] Additionally, the quasi experimental evaluation of the voucher scheme showed the group level causal relationship between expansions of the Kenyan voucher mechanism and changes in the quality of post natal care [17]. On the other hand, other researcher have described the community experiences and perception of the clients on the voucher schemes [18] and a longitudinal analysis on facility based delivery in slums [19]. A comprehensive review worldwide voucher schemes revealed the lessons and practices learnt from different schemes [11] and a policy analysis on the reproductive voucher schemes described the implementation process of the Kenyan voucher program [20].…”