Kenya – Innovative health voucher system for urban poor
At the recently constructed semi-permanent Canna Medical Centre in Viwandani slums, Nairobi, Grace Nyambonyi and her baby girl Mary, have come for one of their final post-natal visits.
The happy baby plays on her mother’s lap as the latter chats with Penninah Nyamboke, a friend who has accompanied them.
Ms Nyambonyi and Ms Nyamboke are residents of one of the many slums dotting the city, this one being home to approximately 42,000 residents.
Unlike hundreds of other children born in the slums, Mary was not delivered at home under unsafe conditions, thanks to the Safe Motherhood (SMH) voucher that covered the delivery costs at the health centre.
Ms Nyambonyi is one among hundreds of women in Kenya who have benefited from donor supported programs that have successfully boosted health care provision to the poor.
The government is now duplicating such models in developing health financing policy and designing strategies for facilities through performance based funding.
Ms Nyambonyi’s voucher, purchased for Sh200 under the Output Based Approach (OBA) pilot program — a Kenya Government initiative supported by the German Financial Cooperation, Kfw — has given her access to free pre and post-natal clinic visits at a health centre of her choice throughout her pregnancy.
Emergency expenses such as complications and referrals to larger hospitals are also catered for under the program.
The expectant mothers also receive food rations consisting of seven kilograms of corn soya and a litre of cooking oil at each visits courtesy of the World Food Program, to help them at a time when they are not able to work.
“This program has been very helpful because we deliver safely, complications are treated quickly and our babies are healthy” said Ms Nyambonyi.
She was allowed to purchase the voucher after staff hired by the Voucher Management Agency (VMA) – a private firm that manages this program — visited her house and gave her a chance to carry her pregnancy to term and deliver safely under a skilled health official, reducing the risk of complications that sometimes results in a lifetime of infections and even death.
“When mothers deliver at home, screening for HIV cannot be done, use of unsterilized implements leads to infection and birth notification forms are not available” said Mr Joseph Mambo, Director at Canna Medical Centre.
Ms Nyambonyi also has to certify on claim forms that are processed by VMA that she received satisfactory service before payment is made to the health facility — something new in the provision of health services.
Under a Kfw supported pilot project and similar UNICEF supported program in North Eastern Province, the low cost of the vouchers has led to increased health facility deliveries and uptake of family planning methods, an indication that high costs hinder the poor from accessing health care.
There has also been behavioural change with more women choosing to go to hospital for treatment of other ailments.