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Introduction: In developing countries, the poor and vulnerable are unable to access basic healthcare needs due to health financing related constraints. Healthcare needs are mostly financed through out of pocket, resulting in catastrophic expenditure. In 2006, the government of Kenya in partnership with Kfw implemented the Output-Based Aid (OBA) voucher programme to increase access for family planning and birth delivery in four counties in Kenya. However, evidence on the progressivity of the Output Based Aid voucher and its impact on FP and maternal healthcare services in Kenya is limited. The objective of this study was to examine progressivity of the OBA voucher programme and its effect on Long Term Family Planning methods and maternal health in Nairobi and Kiambu Counties of Kenya. The study adopted a case study research design, using data obtained from Kenya Ministry of Health (MOH).The Benefit Incidence Analysis (BIA) and binary probit regression model was used to analyse progressivity of the OBA voucher programme and its effect on Family Planning and Maternal Health. The findings showed that the OBA voucher programme was regressive because it did not benefit poor women. However, the study revealed that the OBA voucher programme had a positive effect on the utilization of maternal health acrossthe two counties. Based on the findings, thisstudy can be used to inform the design and implementation of the UHC particularly by ensuring that financing of family planning and maternal health services is progressive.

Background: Increasing access to health care has been a policy concern for many governments, Kenya included. The Kenyan government introduced and implemented a number of initiatives in a bid to address the healthcare utilization challenge. These initiatives include 10/20 policy, exemptions for user fees for some specific health services (treatment of children less than five years, maternity services in dispensaries and health centers, Tuberculosis treatment in public health facilities), and increase in the number of health facilities and health workforce. These initiatives notwithstanding, healthcare utilization in Kenya remains a challenge. The Kenya Household Health Expenditure and Utilization Survey of 2007 found that 17 percent of those who needed health care services could not access the services from both government and private health facilities largely due to financial constraints. This paper employed econometric analysis to examine what could be constraining health care utilization in Kenya despite all the efforts employed. Methods: Using the 2007 Kenya Household Health Expenditures and Utilization Survey (KHHEUS) data (n = 8414), this paper investigates the factors that affect health care utilization in Kenya by estimating a count data negative binomial model. The model was also applied to public and private health facilities to better understand the specificities of poverty in these two facility types. Common estimation problems of endogeneity, heterogeneity, multicollinearity and heteroskedasticity are addressed. Findings: The econometric analysis reveals that out-of-pocket expenditures, waiting time, distance, household size, income, chronic illness area of residence and working status of the household head are significant factors affecting health care utilization in Kenya. While income and distance are significant factors affecting public health care utilization they are not significant in explaining healthcare utilization in private facilities. In addition, working status of the household head, insurance cover and education are significant in explaining private and not public health care utilization. A striking finding is the positive relationship between distance and health care utilization implying that people will travel long distances to obtain treatment. This is perhaps associated with expectations of higher quality of care at far away higher level facilities, especially in rural areas. Conclusion: The paper confirms the existing evidence of the negative effects of Out-of-Pocket (OOP) expenditures and other determinants of health care utilization. With a better understanding of why people use or do not use health services, health care organizations can seek to improve the quality of human life. The bypassing of health facilities for higher level far away facilities implies that it is not so much about availing health facilities, but the quality of the services offered in those facilities. The government should therefore assure quality to increase utilization of the lower level facilities, especially in the rural areas.

Background: Out-of-pocket health expenditures leave households exposed to the risk of financial catastrophe and poverty whenever they entail significant dissaving or the sale of key household assets. Even relatively small expenditures on health can be financially disastrous for poor households and similarly, large health care expenditures can lead to financial catastrophe and bankruptcy for rich households. Objective: There is increasing evidence that out-of-pocket expenditures act as a financial barrier to accessing health care, and are a source of catastrophic expenditures and impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and impoverishment in Kenya. Methods: Using Kenya Household Health Expenditures and Utilization Survey data of 2007, the study uses both descriptive and econometric analysis to investigate the incidence and intensity of catastrophic health expenditures and impoverishment as well as the determinants of catastrophic health expenditures. To estimate the incidence and intensity of catastrophic expenditures and impoverishment, the study used both Wagstaff and van Doorslaer, (2002) and Xu et al. (2005) and applied various thresholds to demonstrate the sensitivity of catastrophic measures. For determinants of catastrophic health expenditures, a logit model was employed. Findings: Among those who utilized health care, 11.7 percent experienced catastrophic expenditures and 4 percent were impoverished by health care payments. In addition, approximately 2.5 million individuals were pushed into poverty as a result of paying for health care. The poor experienced the highest incidence of catastrophic expenditures. Conclusion: The paper recommends that the government should establish avenues for reducing the burden of out-of-pocket expenditures borne by households. This could be through a legal requirement for everyone to belong to a health insurance and targeting the poor, the elderly and chronically ill through the devolved system of the government and devolved funds.