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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.
Highlights
Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers
Knowledge of vouchers benefit package and technical competence for providing the services Our findings demonstrate different levels of awareness among healthcare providers and managers in relation to the vouchers benefit package across the facilities
Facility managers had better awareness of the family planning (FP) and safe motherhood (SM) services package compared to the healthcare providers
Summary
Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. Results-based financing has emerged as a potentially significant strategy to finance health and other social protection services in the health sector. It is mainly used for expanding the quantity and quality of targeted subsidized health services [1,2,3,4]. Results-based financing include initiatives such as output-based aid (OBA), pay for performance, cash on delivery and performance-based financing [5,6,7] It includes a range of health initiatives aimed at achieving health targets such as improvement.
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