Understanding the Challenges and Opportunities in sustaining health interventions during the transition from external assistance: A Case study of the Output-Based Voucher Scheme in Kenya

Abstract

Abstract Background Kenya's economic shift has transformed donor aid in healthcare, prompting an examination of its ability to maintain health intervention coverage without donor funding. The study focuses on the Output Based Approach (OBA) Voucher Programme (2005–2015), investigating subsidized safe motherhood services for the economically disadvantaged. Methods Utilizing a mixed-methods approach, we used a single group Interrupted Time Series design to analyse quantitative data from the District Health Information System (DHIS2) between January 2012 and December 2018. Thematic analysis of qualitative data from key informant interviews provided additional insights. Findings: Post-donor funding cessation, notable declines in key indicators were observed. Committed political leadership, increased funding, and initiatives like Universal Health Coverage (Linda Mama) countered these declines. Initially marked by challenges like corruption, implementation hurdles were systematically addressed through phased strategies, bilateral agreements, and supportive policies. Stakeholder engagement, initially lacking, improved through sustained interaction with key actors and the government. Conclusion The study underscores the need to fortify health system capacity and highlights the critical role of supportive policy frameworks in sustaining health intervention coverage. These insights offer valuable guidance for policymakers aiming to enhance sustainability in Kenya and analogous contexts, especially amid declining external funding.