Community experiences and perceptions of reproductive health vouchers in Kenya

Rebecca Njuki,Wilson Mukuna,Lucy Kanya,Piet Bracke,Timothy Abuya,Ben Bellows,Charlotte Warren,Francis Obare,Jerry Okal,Ian Askew

doi:10.1186/1471-2458-13-660

Rebecca Njuki, Wilson Mukuna + Show 8 more

Open Access

https://doi.org/10.1186/1471-2458-13-660

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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.

Highlights

Research 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
In OBA voucher programs, a voucher management agency (VMA) distributes or sells vouchers for specific services at a subsidized price to intended beneficiaries, and reimburses healthcare facilities for providing services to clients presenting with vouchers
Awareness about vouchers Results from the household survey show that the safe motherhood voucher was the most well known while the gender-based violence recovery services (GBVRS) voucher was the least known

Summary

Introduction

Research 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. Experience has shown that routine financing of health inputs such as staff costs, equipment and buildings without associating these inputs with the services (outputs) delivered does. One such financing mechanism is the output-based aid (OBA), which targets the poor and under-served populations with subsidized essential health services [5,9]. OBA programs invite service providers (public, non-profit or private-for-profit) to participate Those agreeing to participate can only do so if they demonstrate service provision at a specified standard of quality of care. A number of providers are accredited to create competition and give consumers choice

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