Does a voucher program improve reproductive health service delivery and access in Kenya?

Abstract

BackgroundCurrent assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program.MethodsA total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents.ResultsFacility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions.ConclusionsPublic and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong

“…Findings offer possible directions in refining the implementation strategies of current EHCVS. For practice implications, first, to encourage disease prevention and management, a targeted voucher programme with community education is preferable (Njuki et al., ). The purpose of EHCVS has to be clarified for the public so that vouchers can be used wisely.…”

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.…”

“…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. [26][27][28][29][30] The postintervention data were collected in the same communities included in the 2012 study and involved both quantitative and qualitative components. The qualitative component, which provides data for this paper, aimed to identify the process and complexities of implementing FMS, understand factors that influence women to seek facility-based deliveries with and without user fees, and examine stakeholders' views regarding the transitioning of FMS to NHIF.…”

“…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 …”

“…The results of this initiative indicated promising opportunities for improving access, coverage, and quality for targeted low-income beneficiaries. [26][27][28][29][30] Following the failure of the 2005/2006 NSHI bill, 2 years later, Kenya embarked on a process to develop a HCF strategy. A draft HCF strategy was started in 2009, but this was not finalized due to lack of effective linkages with social security sectors; limited involvement and coordination of key government departments and lack of explicit and systematic stakeholder analysis; poor communication; and limited public debate.…”