Progressivity of the Output Based Aid Voucher Programme and Its Effects on Family Planning and Maternal Health in Nairobi and Kiambu Counties, Kenya

Abstract

Developing countries are yet to attain the status of developed country in providing healthcare to the population. Low income countries have high unmet need for family planning because of the barriers to accessing contraceptives. Despite increase in utilisation of contraceptive among women in Sub-Sahara Africa, use of Long-Term Family Planning (LTFP) contraceptive methods remain low partly because of high cost of these methods. In developing countries, the poor and vulnerable households are unable to access basic healthcare due to health financing related constraints. To improve equity in health care in Kenya, the Output-Based Aid (OBA) voucher programme was implemented in 2006. However, despite the implementation of the OBA, there is no study to determine progressivity of the programme. The specific objectives of this study were to analyse progressivity of the OBA voucher programme and, to investigate the effect of the OBA voucher programme on LTFP and maternal health in Nairobi and Kiambu Counties of Kenya. This study adopts a case study research design. Secondary data was obtained from the database of the Kenya Ministry of Health (MOH). The Benefit Incidence Analysis (BIA) was used to analyse progressivity of the OBA voucher programme while the binary probit regression model was used to analyse the effect of OBA on Family Planning (FP) and Maternal Health (MH). The results showed that the OBA voucher programme was not progressive because it did not benefit neither poor women nor those classified as the poorest of the poor. On Family Planning (FP) and Maternal Health (MH), the finding established that OBA voucher programme had a positive effect on the utilization of FP and MH. The study recommends that similar programmes should pay attention to design and stepwise implementation in order to achieve equity. The results also provide useful lessons to planners responsible for the implementation of Universal Health Coverage (UHC) in Kenya, in particular ensuring demand side factors s that will hinder utilization of FP & MH service are adequately addressed in the financing of the UHC.