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

BMC Public Health

Ben Bellows¹  Ian Askew¹  Lucy Kanya¹  Francis Obare¹  Jerry Okal¹  Charlotte E Warren¹  Rebecca Njuki¹  Timothy Abuya¹ 

[1] Population Council Nairobi, Nairobi, Kenya

关键词: Policy analysis;    Family planning;    Safe motherhood;    Maternal health;    Vouchers;    Reproductive health;    Output-based approach;   

Others  :  1163435
DOI  :  10.1186/1471-2458-12-540

 received in 2012-01-31, accepted in 2012-07-04,  发布年份 2012

【 摘 要 】

Background

Innovative 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.

Methods

Policy 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.

Results

The 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.

Conclusions

OBA 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.

【 授权许可】

   
2012 Abuya et al.; licensee BioMed Central Ltd.

【 图 表 】

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