Does a voucher program improve reproductive health service delivery and access in Kenya?

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. Methods - A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analysed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Results - Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Conclusions - Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.This work was supported by the Bill and Melinda Gates Foundation to the Population Council as part of a multi country study evaluation of voucher-andaccreditation interventions. Grant number 51761

The importance of local forest benefits: Economic valuation of Non-Timber Forest Products in the Eastern Arc Mountains in Tanzania

Understanding the spatial distribution of the quantity and economic value of Non-Timber Forest Product (NTFP) collection gives insight into the benefits that local communities obtain from forests, and can inform decisions about the selection of forested areas that are eligible for conservation and enforcement of regulations. In this paper we estimate transferable household production functions of NTFP extraction in the Eastern Arc Mountains (EAM) in Tanzania, based on information from seven multi-site datasets related to the behaviour of over 2000 households. The study shows that the total benefit flow of charcoal, firewood, poles and thatch from the EAM to the local population has an estimated value of USD 42 million per year, and provides an important source of additional income for local communities, especially the poorest, who mainly depend on subsistence agriculture. The resulting map of economic values shows that benefits vary highly across space with population density, infrastructure and resource availability. We argue that if further restrictions on forest access to promote conservation are considered, this will require additional policies to prevent a consequent increase in poverty, and an enforced trade-off between conservation and energy supply to rural and urban households