title: Does a voucher program improve reproductive health service delivery and access in Kenya?
abstract: BACKGROUND
  Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program.
  
  
  METHODS
  A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analyzed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents.
  
  
  RESULTS
  Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions.
  
  
  CONCLUSIONS
  Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.
authors.affiliation: Centre for Population Health Research and Management, P.O BOX 1907-00202, Nairobi, Kenya. njuki.rebecca@gmail.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Njuki
authors.affiliation: Population Council, P.O Box 17643-00200, Nairobi, Kenya. tabuya@popcouncil.org.
authors.forename: Timothy
authors.initials: T
authors.lastname: Abuya
authors.affiliation: Population Council, P.O Box 17643-00200, Nairobi, Kenya. jkimani@popcouncil.org.
authors.forename: James
authors.initials: J
authors.lastname: Kimani
authors.affiliation: Population Council, P.O Box 17643-00200, Nairobi, Kenya. lkanya@popcouncil.org.
authors.forename: Lucy
authors.initials: L
authors.lastname: Kanya
authors.affiliation: Department of Sociology, University of Nairobi, P.O Box 30197-00200, Nairobi, Kenya. allan.korongo@gmail.com.
authors.forename: Allan
authors.initials: A
authors.lastname: Korongo
authors.affiliation: Department of Sociology, University of Nairobi, P.O Box 30197-00200, Nairobi, Kenya. collinsmukanya@gmail.com.
authors.forename: Collins
authors.initials: C
authors.lastname: Mukanya
authors.affiliation: Ghent University, B-9000, Ghent, Belgium. piet.bracke@ugent.be.
authors.forename: Piet
authors.initials: P
authors.lastname: Bracke
authors.affiliation: Population Council, P.O Box 17643-00200, Nairobi, Kenya. bbellows@popcouncil.org.
authors.forename: Ben
authors.initials: B
authors.lastname: Bellows
authors.affiliation: Population Council, 4301 Connecticut Ave NW, 20008, Washington, DC, USA. cwarren@popcouncil.org.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Warren
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D005380:Financing, Government / Q000191:economics*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006293:Health Promotion / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007630:Kenya; D008297:Male; D008427:Maternal Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D015397:Program Evaluation; D034121:Reproductive Health Services / Q000191:economics* / Q000706:statistics & numerical data*