Vouchers: making motherhood safer for Kenya’s poorest women
Germany’s contribution to the achievement of MDG5 in Kenya
- Donika Dimovska of Results for Development
- Guy Stallworthy of the Bill and Melinda Gates Foundation
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, March 2012
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.