Menu
Menu
Menu
Menu
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.
The paper draws from qualitative data collected in 2010 as part of a larger quasi-experimental design aimed at evaluating the impact of the Kenyan OBA voucher scheme on increasing access to, and quality of, selected reproductive health (RH) services [22]. These data were derived from in-depth interviews (IDIs) with facility managers and healthcare providers from program sites in Kitui, Kiambu, Nairobi, and Kisumu. The IDIs took place alongside quantitative health facility assessments and population surveys aimed to measure the impact of the voucher program on access to health facilities and quality of services. Details of the larger evaluation and population surveys are discussed elsewhere [22]. The in-depth interviews aimed at gaining a deeper understanding of the perceptions and priorities of the health care providers regarding the voucher program. The interview guide was amended appropriately after pre- testing the tools. The in-depth interview guide focused specifically on: (i) technical knowledge of services offered using the voucher (ii) attitudes towards the voucher program iii) benefits and (iv) challenges of the voucher program, processes and the approach (v) and perceptions on program implementation. A total of 69 interviews with facility managers (n = 30) and healthcare providers (n = 39) working at 30 OBA accredited public, private, and faith-based facilities were conducted. These facilities were randomly sampled from the 54 voucher accredited facilities selected to participate in the first phase of the Kenya OBA program. We planned to interview the facility manager and healthcare providers working in the reproductive health units in the study facilities. However, in some facilities the facility managers were not present on the days of the interviews, therefore interviews were only conducted with the healthcare providers directly involved with reproductive health or maternal and child health services. Overall the study interviewed 46 females and 23 males from facilities ranging from dispensaries to hospitals. Table 1 presents the distribution and composition of healthcare providers and managers. Distribution and composition of service providers and managers The IDIs were tape recorded and transcribed into a Microsoft Word file. The transcribed texts were then transferred to NVIVO 10 qualitative data analysis software. Qualitative data analysis was done by two researchers to ensure reliability in the coding and results. The study hypothesized that a voucher program would improve reproductive health service delivery and access to target population. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Following coding, a full list of themes was available for categorization within a hierarchical framework of main and sub-themes. The thematic framework was then systematically applied to all of the interview transcripts. We looked for patterns and associations of the themes and compared and contrasted within and between the providers and facility managers in different regions, sectors and levels. Ethical approval for the evaluation was granted by Population Council’s Institutional Review Board (IRB) No. 470 and Kenya Medical Research Institute (KEMRI) SCC 174. Informed consent was obtained prior to all interviews that were conducted in settings that ensured privacy and confidentiality. Participants were informed that they could withdraw from the research at any time. Data collectors were trained on ethical conduct.
N/A
