INCLUDE Platform

Maternity fee waiver in Kenya

Comparing the impact and cost effectiveness of two social protection interventions in Kenya: fee waiver versus social health insurance scheme

This study investigates the cost effectiveness and impact of social protection interventions in the health sector and how these interventions can improve health outcomes and, thereby, contribute to inclusive growth. Such interventions directly affect the affordability of healthcare for the poor. The government of Kenya prioritizes equitable healthcare and health financing in recognition of the fact that user fees at primary care facilities and for maternal healthcare constitute a barrier to access to healthcare. Consequently, in 2013, the government implemented a Free Healthcare Policy (FHP), which led to the waiver of all user fees for maternity services in all public health facilities. Another way to offer social protection and ensure a household’s access to quality healthcare is to offer them an affordable health insurance package, such as the Community Healthcare Plan (TCHP) for dairy farmers in the informal sector in Nandi County, Kenya. This study, therefore, seeks to compare the cost effectiveness of the free maternal care available in all public facilities and free primary care available in public dispensaries and health centres in Kenya with the TCHP in Nandi County, Kenya. The main question is: how cost effective is provision of free maternal care in all public facilities and free primary care in public dispensaries and health centres in Kenya compared to the TCHP in Kenya’s Nandi County in terms of targeting, quality of care, utilization and out-of-pocket expenditure – and what are the transmission channels from these indicators to inclusive growth?

This study will use available quantitative and qualitative data from the evaluation reports of the two interventions. The research will model some of the effectiveness results for the free primary care, estimate the short-term impact on the selected indicators using a before and after methodology, and, if possible, compare these with a counterfactual group for the government’s policy. To overcome the challenge of using data collected for other purposes, the researchers will use multiple datasets to crosscheck the robustness of findings.

The knowledge generated by this study will be useful in formulating policies on cost-effective social protection interventions in health. The consortium is made up of members knowledgeable on the two interventions and has a wide network through which to lobby for policy change.

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  • African Population and Health Research Center
  • Amsterdam Institute for International Development (AIID)
  • Health Policy Project
  • PharmAccess Foundation

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