Deriving from the health indicators it was felt that reproductive health interventions need to be addressed in addition to the various health care programs in context of Kenyan German Cooperation. Services offered especially to the economically disadvantaged parts of a population must be affordable as well as accessible. Efficiency and effectiveness of health care delivery needs to be strengthened further.
Recent demographic health surveys confirm these objectives by showing the total fertility rate is increasing in Kenya while the contraceptive prevalence rate is stagnant and mother-child health indicators are worsening. The Governments of Kenya (GoK) and Germany agreed to commit funds to improve service delivery subject to a program appraisal by the German KfW Banking Group. In preliminary discussions both sides agreed to use a new model for service delivery, the Output Based Aid (OBA) approach. The OBA concept envisages financing agreed outputs rather than pre-defined inputs by selling vouchers for reproductive health and family planning services at subsidized prices to patients. These vouchers will be refunded to service providers in the private sector (medical doctors, qualified nurses and midwives), government hospitals, NGOs (non-governmental organizations) and faith based organizations.
OBA is considered to be an approach which eventually might be combined with a social health insurance scheme once such a scheme is operational and capable of providing acceptable health insurance coverage to the envisaged target groups. The project is expected to improve the delivery of reproductive health services in the short run, thus contributing directly towards reaching the UN Millennium Development Goals on maternal mortality and child mortality.
Experiences will be exchanged mutually between the National Hospital Insurance Fund (NHIF) and OBA in order to create a learning atmosphere on technical issues such as targeting, accreditation, claim processing, reimbursement and quality assurance. Medium to long-term the approach is seen as contributing to the goal of the GoK in creating an efficient and quality health care system accessible, equitable and affordable by every Kenyan household.
A feasibility study conducted in May 2004 and lead by IGES Institute, Berlin, provided the outline to an implementation concept and recommended a close cooperation of several Government agencies, giving the National Coordinating Agency for Population & Development (NCAPD) a vital part. The World Bank expressed interest in the conceptual approach and, as part of a reprogramming of funds for Kenya, may assess options of co funding the scheme.