Consultancy Services for Accreditation and Quality Assurance System for Output-Based Aid (OBA) Programme for Safe Motherhood, Sexual GBV and Family Planning, Phase III
Year - 2011 - 2016
Client - Reconstruction Credit Institute/Kreditanstalt für Wiederaufbau (KfW)
Through support by the Federal Ministry for Economic Cooperation and Development (BMZ) and KfW Banking Group, the Government of Kenya has, since 2005, been piloting a new model to help the poor access good quality reproductive healthcare and aims to provide gender violence recovery services to economically deprived segments of populations dubbed as 'Output-Based Aid' (OBA) or also called 'Vouchers for Health' Programme. This OBA programme is a Flagship vision 2030 project of the Kenyan Government. By the end of Phase II which was implemented by IPE Global from 2008 to 2011, an estimated 234,886 women of reproductive age or 24% of the target population were reached in the five regions of Kilifi, Kisumu, Kiambu, Kitui and Nairobi). The success of both phases encouraged the government and development partners to conceive Phase III (running from November 2011 to October 2014, later extended to December 2016). The overall objective of the programme is to reduce maternal and infant mortality through improved delivery of reproductive health services. IPE Global's key engagement relates to quality assurance and accreditation of health care facilities in the OBA managed counties as well as designing, developing and implementing healthcare quality management and accreditation systems.
In the early stages, the OBA programme lacked any institutionalized quality assurance and accreditation system. The voucher agency itself selected healthcare facilities for the OBA Programme without verifiable standardised service protocol. This, however did not yield satisfactory results. IPE Global stepped in as External Consulting Agency for the project at the national level to set up initial accreditation of the facilities and improved on the OBA quality assurance tool by conducting a patient satisfaction survey and medical audit of 20 patient cases using OBA services. IPE Global developed their QA capacity and quality monitoring, setting up QA tools that generated reports at regular intervals. It then conceptualised and formulated orientation and training programmes on QA and Accreditation tools. Facilities are reassessed every six months and those failing on the indicators are diaccredited and are advised to reform service quality within three month before reapplying so that service standards are maintained at all times. As of March 2016, 382 healthcare facilities have been accredited under the OBA programme in Kenya.
Among the challenges encountered during implementation of the project, has been the sensitisation of the population on the value of the voucher system and the need to secure some prepaid health scheme. Strengthening social marketing activities has been seen as an important way of mitigating this. Others have included the slow approval processes of revised accreditation and quality assurance systems, particularly since accreditation is a new approach and requires buy-in from healthcare providers.
The OBA voucher system has influenced policies and practices by effectively targeting specific populations and improving the quality of services. It has also generated an increase in utilizing specified health goods/services as well as a more efficient distribution compared to other forms of aid distribution. Women no longer have to live with the fear of complications that could financially ruin their families as they can now choose from a list of accredited facilities, public or private, to deliver their babies. Financing is agreed on outputs of pre-defined quality rather than financing pre-defined inputs. This greatly contributed to value for money. Real-time Web Based Data Collection Method has been used and some donors have expressed interest in replicating lessons from IPE Global on this. As a result of this project, IPE Global has been empaneled in the Kenya Accreditation Services (KENAS), a national accreditation body.
Through IPE Global interventions, the following has been achieved under the project:
- Key role in consistent reduction in Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) in Kenya over the years (2011 – 2015)
- Improved quality of services where revenues are used to improve facility infrastructure and staffing
- Family planning is a major component of health education and skilled birth
- Awareness raising of individual rights where gender based violence occurs
- Programme found relevant, efficient and sustainable and a good model for UHC
- Voucher system has encouraged health seeking behavior and better targeting amongst the poor population
- A vibrant internal, external MIS and M&E mechanism in place to help detect and mitigate undesirable behavior with the sector
- QA and accreditation processes have generated authentic data that can support the government in healthcare MIS for further improvement in healthcare in Kenya.