title: A policy analysis of the implementation of a Reproductive Health Vouchers Program in Kenya.
abstract: 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.
authors: Population Council Nairobi, Nairobi, Kenya. tabuya@popcouncil.org
authors: Timothy
authors: T
authors: Abuya
authors: Rebecca
authors: R
authors: Njuki
authors: Charlotte E
authors: CE
authors: Warren
authors: Jerry
authors: J
authors: Okal
authors: Francis
authors: F
authors: Obare
authors: Lucy
authors: L
authors: Kanya
authors: Ian
authors: I
authors: Askew
authors: Ben
authors: B
authors: Bellows
mesh_terms: D005380:Financing, Government; D006291:Health Policy; D006801:Humans; D007630:Kenya; D011050:Policy Making; D016730:Program Development; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000191:economics*