Source:The East African
Sophia Waithera, a 22-year- old mother has given birth to a bouncing baby girl at Jahmii Kipawa Medical Centre deep in Nairobi's sprawling Korogocho slum.

Were it not for a voucher scheme initiated by the Kenyan Government and a German agency, Ms Waithera would have delivered the child at home as hundreds of poor mothers in the slums do, risking the lives of their newborn babies.

The Voucher Scheme Reproductive Health Output Based Approach (RH–OBA) introduced in 2005 to assist mothers deliver at a cost of $2.3 was meant to curb rising maternal and child mortality among poor Kenyan households.

"I purchased the voucher for only $2.3 in February this year and I have been using it for all my antenatal clinics. It will now cover my delivery charges," Ms Waithera said.

Sylvia Macharia, a nurse at the clinic said the project had raised the number of deliveries, cut child mortality rate and reduced cases of low birth weights. "Previously, we only had two to three deliveries a month, now we get at least 30, " she said.

"Mothers are give given free medical checkups, advice on taking care of themselves and the unborn baby in addition to food supplements," said Ms Macharia.

Each mother is given about 7.5 kilogrammes of flour every month and one litre of cooking oil from WFP. Funded by the German Development Bank KFW, the Voucher Scheme is meant to improve access to and uptake of reproductive health services to poor households mainly in rural areas and urban slums.
"RH-OBA is a demand side financing model where funds are only paid out after agreed upon outputs are achieved. In this case the expected outputs are quality health care services," said Piet Kleffman, Director KFW.

In the 2010/11 fiscal year, Kenya allocated $102.2 million for the project through the Ministry of Public Health and Sanitation. Germany donated $17 million for the first and second phases of the programme.

Kenya hopes this project will help it achieve the Millennium Development Goal Five calling for reduction of childhood and maternal mortality rates through medically assisted deliveries, immunisation of the children and use of contraceptives.

The programme is currently running in three rural districts of Kitui, Kisumu and Kiambu and two slum areas of Nairobi; Korogocho and Viwandani and recently in Kilifi.

The programme offers three services which include Safe motherhood voucher, family planning and fighting gender violence.

Voucher packages

The Safe motherhood voucher package of services costs $2.3 which entitles women to antenatal care, delivery services including Caesarian sections when needed, postnatal care for mothers and babies for six weeks after delivery, treatment of complications and referral to hospitals when needed as well as health education and counselling.

The Family Planning voucher entitles women to long term contraceptive methods including monitoring, referrals and consultation and the voucher for this package is $1.1.

The Gender Based Violence Recovery voucher that is free of charge includes medical treatment and psycho-social counseling for the survivors.

The vouchers are only sold by a third party agent that has been selected and managed by PricewaterhouseCoopers and contain the name, date of issue and Identification card number of the client or guardian if the client is below 18 years.

No health facility distributes the vouchers, a design that serves to ensure that there is no embezzlement of funds. The beneficiaries are identified using a poverty tool that assesses the housing, access to health services, rent/land ownership, number of meals per day, water sources and sanitation.

The vouchers are accepted by accredited health facilities; both government hospitals and NGOs which are reimbursed after delivery of their services to the clients.

For any caesarian section done for the mothers, the health facility is reimbursed a total of $292, normal deliveries $70, surgical contraceptives $42, implants $28 and IUCD $14.

The health facilities are required to improve the existing health facilities using these reimbursements by ensuring that patients have the purchasing power to buy the services.

A recent government survey shows that the poor living both in the rural and urban areas have very limited access to quality health care and as a result the health indicators are below national averages.

Results so far indicate that the Safe motherhood voucher is popular and was used by 66,820 women in the second phase of November 2008 to January 2011. The number dropped to 54,416 due to couples now making use of contraceptives.

Initially 8,835 people used the Family Planning Voucher but the number has risen to 13,795. From the report, until the programme had been initiated the use of contraceptives in the area was on a decline.

The Gender Violence Voucher that is free was only used 352 times in the first phase but in the second phase rose to 1,115.
The third phase of the programme will start in November 2011 this year according to Mr Kleffman.

Patrick Waiganjo, a clinical officer and owner of the Jahmii Kipawa Medical clinic one of the health facilities under the programmme admits that for the three years he has been in the programme he has been able to expand and renovate his clinic from the usual outpatient to now a fully equipped health clinic that has inpatient rooms and delivers at least 20 to 30 mothers a month.

"Since I joined the number of my clients has been increasing for both the people in the programme and those who are not in the programme and I have been able to increase my professional staff number from two to now eight", said Mr Waiganjo.

The services of the accredited health facilities are evaluated in regard to the human resources, equipment, drugs and performance and required to meet the standards defined by the Kenya's Ministry of Medical Services and Public Health and Sanitation.

An Independent body also selected and supervised by PWC monitors the services and regularly interviews the clients. They also visit the health facilities for inspection and the distribution points regularly.

Results from the first phase and part of the second phase indicated that the Safe motherhood voucher is popular and was used by 66,820 women in the second phase of November 2008 to January 2011 and is ongoing, the number dropped to 54,416 due to couples now making use of contraceptives.

Also in the first Phase, 8,835 people used the Family Planning Voucher but in the second phase the number rose to 13,795.
From the report, until the programme had been initiated the use of contraceptives in the area was on a decline.

The Gender Violence Voucher that is free was only used 352 times in the first phase but in the second phase rose to 1,115.

"The success of the voucher scheme has improved access to quality health services and the competition between the health facilities has led to improved service provision to the people", said Mr Kleffman.