Center for Health Market Innovations (CHMI)

Programs

Kenya Output-Based Aid Voucher Program

last updated May 14, 2012

Overview

Implementing organization: 
Kenya National Coordinating Agency for Population and Development, PriceWaterhouseCoopers
Implementation Partner(s): 
Ministry of Public Health and Sanitation/Ministry of Medical Services, The National Co-ordinating Agency for Population and Development, Population Council, PriceWaterhouseCoopers, IGES GmBH, EPOS Health Management, The National Hospital Insurance Fund, University of California-Berkeley School of Public Health
Legal Status: 
State/government
Year Launched: 
2005
Stage: 
Existing/expansion stage
Income Level of Target Population: 
Bottom 20%

Funding

Primary Source of Funding: 
Donor
Additional Source(s) of Funding: 
Government, Out-of-pocket payments
Funders: 
BMZ (Federal Ministry for Economic Cooperation and Development), German Development Bank (KfW)

Scale

Number of Clients Served: 
In the first phase of the programme 66,820 women used the safe motherhood voucher. In the second phase, the number dropped to 54,416. The decline was due to more couples making use of contraceptives thanks to the family planning voucher. In the first phase 8,835 people used the family planning voucher, in the second 13,795 did. in the first phase 352 people used the gender violence voucher. in the second 1,115 used it.
Summary: 

The Reproductive Health Output-Based Aid (OBA) Voucher Program is a performance-based reproductive health program that incentivizes access to women’s healthcare.

Program goals/rationale: 

According to Kenyan statistics, of 100,000 women who give birth, 488 die. Birth rates and death rates are especially high among poor women. A hospital birth costs at least the equivalent of Euro 250. Hospitals, moreover, are neither equipped nor funded adequately. Most Kenyans pay for medications and treatments out of their own pockets. Pregnancies and births often become an intolerably heavy financial burden on families. Many women give birth at home, often under poor hygienic conditions.

Key program components: 

To improve Kenyan healthcare systematically and allow the poor access to crucial services, KfW, in partnership with the Government of Kenya, is testing an innovative OBA voucher approach.The program is currently in its second Phase (2009-2012) and is being implemented in rural and peri-urban districts in Kenya, representing a population of approximately three million. This voucher initiative is co-funded by the German Development Bank (KfW) and the Kenyan government (US$ 9.55 million for Phase I, 2005-2009).

Three different vouchers are available:

The safe motherhood voucher entitles women to professional antenatal care, delivery services, including caesarian sections, postnatal care for six weeks after delivery, treatment for complications, referral to hospitals when needed, as well as health education and counseling. Members of the target group have to pay Kshs. 200 (USD2.50) for a safe motherhood voucher. The costs it covers can amount to Kshs. 20,000 and higher in case of complications.

The family planning voucher entitles clients to long term contrception methods including monitoring, referral and consultation. Methods of choice include implants (Norplant/Jadelle), intrauterine contraceptive devices (IUCD), female voluntary contraceptive surgery (Bilateral tubal ligation), and male voluntary contraceptive surgery (Vasectomy). The voucher costs Kshs. 100 and buys up to Kshs 3,000 worth of services.

The gender violence services voucher entitles victims to medical and surgical treatment as well as counseling. It is provided to clients free of charge. To ensure accurate targeting of the poorest and economically most vulnerable, a participatory poverty grading tool has been used in the project districts - developed with indicators specific to each district. Markers for poverty included housing, medical access, water source, rent, sanitation, income and number of meals taken per day.

Unlike other voucher programs, this program works with both private and public sector facilities allowing for greater competition and better service coverage. This ensures that government only reimburses the public facilities for specific service based on their service costs rather than on an input basis.

Additional Information

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