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Social protection through maternal health programmes

Inclusive growth through social protection in maternal health programmes in Kenya

Can the maternity voucher system provide more equitable access to care, better health outcomes and greater economic resilience on the household level than the free maternity services policy in Kenya?

This study is about how social protection in maternal health programmes in Kenya contributes to inclusive development. Specifically, this study compares the effectiveness of vouchers targeting vulnerable women and free maternity care in public health facilities. These two interventions were initiated to promote better and more affordable health care, which, in turn, contributes to household productivity and resilience. In Kenya, health expenditure, usually in the form of out-of pocket payments, is a driver of poverty and a barrier to development; hence, social protection interventions are viewed as a means to reduce poverty. This research seeks to provide evidence on the effectiveness of the policy to remove all user fees for maternity care in public health facilities in Kenya and on whether or not this policy is more cost-effective than the free maternity voucher system. This study will, therefore, compare the effectiveness of both interventions, with a focus on healthcare utilization and household asset protection. It will also investigate how these interventions interact with existing formal and informal social support mechanisms, such as micro-credit, health insurance and informal support through kinship obligations.

The research questions are:

  1. What are the optimal interventions in maternal health care in Kenya, taking into account the costs and effectiveness of the interventions together or separately and considering both health outcomes and household asset protection?
  2. Under what geo-socioeconomic and political economy conditions would the maternity voucher system or the free maternity services be preferred or harmonized as a form of investment in the health system?
  3. Does the free choice approach of the maternity voucher system as a social protection intervention protect assets on the household level, and how does this impact upon household productivity and the local economy?
  4. How can the resources in both the voucher system as a social protection intervention and the free maternity services be optimized to promote equity in access to maternal health services in view of the local social security networks?

Data for this study will be gathered through a review of documentation, in particular the Health Information and Management System of Kenya, in-depth interviews and focus group discussions. In-depth interviews will be held with key informants including policy-makers, practitioners, budget personnel in the treasury, donors, health facility management staff and health workers. Discussions will also be held with various groups of health workers, health facility management staff, and the beneficiaries of the voucher system and the free maternity services policy. Analysis will compare the cost-effectiveness of the voucher system with that of the free maternity services provided in public facilities. Indicators to measure effectiveness will be service utilization, the quality of services, health outcomes and out-of-pocket expenditure as immediate outcomes.

Knowledge management activities will include two technical workshops (one in the inception phase and the other during data analysis) and dissemination workshops in Kenya to discuss the evidence generated with various stakeholders. The consortium will also engage in the continuous exchange of information between members through the Smartsheet application and a blog.


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  • Maseno University
  • Ministry of Health Kenya
  • Swiss Tropical Institute
  • University of Bern

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