By: Madeline Taskier, Partnership Coordinator at Women Deliver
Because of high healthcare costs, the poorest women in Kenya often do not have access to maternity care at any point during their pregnancies. On average, a Kenyan woman without health insurance must pay almost $350 USD in order to deliver in a private health facility -- the equivalent of what some Kenyans earn in one year’s salary. Since 2005, the Government of Kenya and the German Development Bank (KfW) have been trying to reduce these cost burdens for poor women with the Output-Based Aid (OBA) Voucher Program.
In three state districts and two slums of Nairobi, the program seeks to reduce the overall maternal mortality burden of 530 deaths per 100,000 live births by providing women and their families with three different types of health vouchers: safe motherhood, family planning, and gender-based violence recovery. The vouchers can be bought for a small fee and used to get a wide range of services free of additional cost—from prenatal visits and long-term family planning methods to ambulance charges and anemia treatment during pregnancy. By buying the safe motherhood voucher, for example, a woman can receive up to four prenatal visits and a safe delivery at a facility for only 2.70 USD (about 200 Kenyan shillings).
Without this program in Kenya, quality and safety in maternity care can come with a large price tag. Before its implementation, only 1 in 4 Kenyans had some sort of health insurance, leaving many Kenyan women paying out-of-pocket for emergency obstetric services. Under the usual circumstances, health facilities had to bear the burden of providing services for people who could not always pay. Now, the facilities that distribute the vouchers (Voucher Service Providers) are reimbursed on a monthly basis by the Government of Kenya with subsidies from the German Development Bank. enabling them to provide high-quality and comprehensive services to Kenyans from diverse socioeconomic backgrounds.
In addition to maternity care and family planning, Kenyan women have lacked access to gender-based violence recovery services due to both cost and cultural stigma. One in five girls is coerced or forced into her first sexual encounter and these numbers increased during the 2008 post-election violence. Purchase of a low cost gender-based violence recovery voucher gives women the ability to receive confidential counseling, HIV testing and prophylactic treatment and other healthcare services in the event of sexual violence.
Over the last five years, the OBA Voucher Program has reached a population of over 3 million people and processed 82,523 safe motherhood claims, 12,643 family planning claims, and 480 gender-based violence recovery claims. An unexpected positive result of the program has been an uptake in facility deliveries from non-voucher clients because of increased awareness of available, high-quality care. Due to the success of the program, the Government of Kenya is effectively financing health care for some of its poorest women and hopes to shape this model into a national social health insurance fund.
- Check out a working paper about the success of the voucher program in Kenya.
- Look into other reproductive health voucher programs in India, Nicaragua, Taiwan, or Uganda.
Photo via Gates Foundation