Vouchers: making motherhood safer for Kenya’s poorest women - Germany’s contribution to the achievement of MDG5 in Kenya

Title page: Vouchers: making motherhood safer for Kenya’s poorest women

Writer: Sue Armstrong
Peer reviewed by Donika Dimovska of Results for Development and by Guy Stallworthy of the Bill and Melinda Gates Foundation

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, March 2012


Read also the Interview with Sue Armstrong, the report’s author, to share her impressions of the programme from her visits to Kenya.


German Development Cooperation has a long history of support for reproductive health in Kenya and, in order to achieve progress towards MDG5, the two governments decided on a voucher scheme to improve access to reproductive health care for the country’s most disadvantaged women. Launched in 2006 with funding from the KfW Entwicklungsbank (KfW) the scheme is today jointly funded by the Kenyan Government.

Voucher programmes are part of what is known as ‘output-based aid’ (OBA), a ‘demand-side’ approach to healthcare financing that is attracting growing interest today. The principle behind such programmes is that women below a certain poverty threshold are sold vouchers, at highly subsidised rates, which entitle them to certain specified services at accredited health facilities. On submission of the voucher and an invoice for their services, healthcare providers are reimbursed by the funding agency, and can decide for themselves how to use the income to support services. Unlike with the more traditional ‘supply side’ model of health care financing, where health services are centrally planned and funds are invested in building and maintaining hospitals and clinics, demand side funds are invested in the client.

Kenya’s voucher programme empowers women in that they can choose which facility to attend from a number of accredited institutions, and change providers if they are unhappy with the service. The OBA approach also introduces competition between facilities, giving them an incentive to improve quality in order to attract clients.

Videos: Vouchers - Making motherhood safer

Kadi - Saving Mothers and Babies, One Voucher at a Time

by Gobee Group PLUS

Kadi - Saving Mothers and Babies (Trailer - 00:55 Min.)

Each year, nearly 8,000 Kenyan women die during pregnancy or childbirth - and another 160,000 are injured or disabled - largely because they lack access to skilled medical attention. With the healthcare systems’ high out-of-pocket fees, poorly staffed facilities, and costly transport from home many poor women believe that high quality maternity care is out of reach.

But now the Kenyan government is exploring an innovative program that gives the poorest women a “kadi,” meaning “voucher” in Swahili. Women can use them like coupons, exchanging vouchers for prenatal and delivery services from approved healthcare. The Population Council is measuring the difference that vouchers make in the lives of women who use them.

Schwangerschaftsgutscheine für kenianische Frauen

Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung (BMZ)

Schwangerschaftsgutscheine für kenianische Frauen (04:59 Min.)

Viele Frauen in Nairobi bringen ihre Kinder unter gesundheitsgefährdenden Bedingungen zur Welt, weil sie aufgrund ihrer Armut keine Gesundheitsdienstleistungen bezahlen können. Die KfW finanziert im Auftrag des BMZ ein Programm, das Frauen Gutscheine für professionelle Geburtshilfe sowie zur Vor- und Nachsorge anbietet. Das Programm erstattet den Krankenhäusern die kompletten Kosten für die erbrachten Leistungen. Auf diese Weise wird einerseits die reproduktive Gesundheit gefördert und andererseits die Finanzierung von Gesundheitsdienstleistungen unterstützt.

Read more at:
Reproductive Health Vouchers Logo
What is a Voucher?

What is a Voucher? (3:32 Min.)

Learn how vouchers work to help provide access to reproductive health for poor women in Africa and Asia.

Episode 1: Vouchers Improve Health Facilities (04:49 Min.)

Without quality and accessible health facilities, financially empowering poor mothers to obtain reproductive health services will prove to be a false promise. Watch this episode to see how four facilities in Kenya and Uganda are benefiting from and using the money provided by voucher mothers.

Episode 2: Mobile Technology for Monitoring Vouchers (04:57 Min.)

Evaluating voucher programs is an intensive process of collecting, organizing, cleaning, and analyzing data. This process needs to happen over largely rural areas with vast distances between households and health service providers. Watch this episode to see how the Population Council and Marie Stopes Uganda are using mobile phones and Open Data Kit to streamline the process of evaluation. 

Episode 3: Vouchers in Pregnancies with Serious Complications (04:47 Min.)

Between 5 -15% of pregnancies face some type of complication. Some of these complications can cause death or severe disability if the mother doesn’t have access to proper health care. The poorest quintile of mothers face the double challenge of lack of resources and a dearth of nearby qualified health facilities. Watch this episode to see how vouchers can be a critical safety net for poor mothers in Kenya.

Episode 4: Getting Vouchers to Those in Need (05:53 Min.)

Getting aid to those in need remains one of the critical challenges of social development. Watch this episode to see how the Kenyan voucher program targets and distributes vouchers to mothers that need them.

Episode 5: Distributing Vouchers in Rural Uganda (04:41 Min.)

Marie Stopes Uganda has been delivering vouchers to poor women in Southwestern Uganda since 2006. Southwestern Uganda presents unique challenges to distributing vouchers and accessing health care because most people live in rural areas. Watch this episode to see the great work that Marie Stopes Uganda is doing to overcome these challenges and make reproductive health care accessible to poor Ugandan women.

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