Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: A qualitative evaluation

Rebecca Njuki,Timothy Abuya,Francis Obare,Chi-Chi Undie,Charlotte E Warren,Ben Bellows,Jerry Okal,Lucy Kanya,Ian Askew

doi:10.1186/1471-2458-12-426

Abstract

BackgroundFew studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services.MethodsA qualitative study was conducted in 2010 and involved: (i) in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and (ii) focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five program sites in Kenya.ResultsThe findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services. These include lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. Moreover, accreditation of only hospitals to offer GBVR services undermines access to the services in rural areas. Poor responsiveness from law enforcement agencies and fear of reprisal from perpetrators also undermine treatment options and access to medical services. Low provider knowledge on GBVR services and lack of supplies also affect effective provision and management of GBVR services.ConclusionsThe above findings suggest that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA program to promote the GBVR services voucher, and conduct widespread community education programs aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers.

Highlights

Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services
Awareness and understanding of GBVR vouchers and services Qualitative findings demonstrated a low of awareness of the GBVR voucher and lack of understanding of the benefit package offered
This led to calls for additional training and clarification on procedures to follow in offering GBVR services

Summary

Introduction

Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services. The estimated lifetime prevalence of GBV among women is between 15 and 71 percent [1,2,3,4]. Estimates from African countries indicate a lifetime prevalence of between 25% and 48% (for example: 48% in Zambia, 47% in Kenya, 34% in Egypt, 30% in Uganda and 25% in South Africa) and an annual prevalence ranging between 10% and 26% [5,6,7]. The need to improve access for survivors of GBV services in subSaharan Africa (SSA) has received increased attention, given the reported linkage between GBV and reproductive health problems [10,11,12,13,14]. GBV has, for instance, been associated with short birth intervals, increased infant mortality, under nutrition among children of abused mothers, and increased incidence of HIV/AIDS and sexually transmitted infections (STIs) [13,15,16,17,18,19]

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Discussion

Conclusion