Improving access to reproductive and child health services in developing countries: are competitive voucher schemes an option?

Bhatia, Mrigesh; Gorter, Anna

doi:10.1002/jid.1361

Cited by 45 publications

(57 citation statements)

References 14 publications

(17 reference statements)

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“…Contracting out is one feature that has been widely documented to facilitate effective delivery of health services but there is limited evidence of how this works in RH voucher programs [8]. This study shows that clear contractual arrangements need to be put in place to facilitate implementation of OBA programs.…”

Section: Discussionmentioning

confidence: 94%

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

et al. 2012

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BackgroundInnovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up.MethodsPolicy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi.ResultsThe OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided.ConclusionsOBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government’s role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.

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Section: Discussionmentioning

confidence: 94%

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

et al. 2012

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“…Unlike the voucher schemes operating in most other countries, 9,12 those in Cambodia do not cover a range of providers but are, instead, restricted to subsidizing maternity care at public facilities, mainly health centres. As such, the vouchers function as fee waivers.…”

Section: Introductionmentioning

confidence: 99%

Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

Poel

Flores

et al. 2014

Bull. World Health Organ.

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“…In OBA voucher programs, a voucher management agency (VMA) distributes or sells vouchers for specific services at a subsidized price to intended beneficiaries, and then reimburses healthcare facilities for providing services to clients presenting with vouchers. OBA programs subsidize specific health care packages based on provision of care with pre-defined quality standards [6,10,11]. Most OBA programs have the following goals: to improve service quality, to stimulate client use of selected services, to target services among high-priority populations where service uptake is low in the absence of the subsidy, and to contain costs [12-16].…”

Section: Introductionmentioning

confidence: 99%

“…Several evaluations of output-based financing schemes for RH services have demonstrated some positive effects of the programs with respect to increased use of skilled birth attendance, hospital deliveries, antenatal care, family planning, health counseling, and sexually transmitted infections (STI) services as well as reduction of inequality to health care access, improvements in quality of services, and reduction in out-of-pocket expenditure [10,15,16,19-23]. There has, however, been little documentation of community perceptions of and experiences with accessing and using reproductive health vouchers.…”

Section: Introductionmentioning

confidence: 99%

Community experiences and perceptions of reproductive health vouchers in Kenya

et al. 2013

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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.

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Improving access to reproductive and child health services in developing countries: are competitive voucher schemes an option?

Cited by 45 publications

References 14 publications

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

Community experiences and perceptions of reproductive health vouchers in Kenya

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