Comparing the impact and cost effectiveness of two social protection interventions in Kenya: fee waiver versus social health insurance scheme

Kenyas maternal mortality rate (MMR) remained high over the last two decades, despite efforts to achieve a 75% drop by 2015 as part of attempts to achieve the Millennium Development Goals. The MMR is even higher among urban and rural poor, recognized vulnerable groups. User fees at primary care facilities and for maternal healthcare constitute a barrier to access healthcare, particularly for vulnerable groups. Waving the user fees at national level is one form of social protection to improve the access to healthcare. Another form of social protection is a social health insurance scheme. The objective of this proposal is to compare the cost-effectiveness of those two types of social protection and to determine the transmission channel from the short-term impact of the two approaches to medium-term inclusive growth. We do this using two programs each representing one of the two approaches and highly comparable in terms of time and space. We will measure the cost of both programs, as well as the impact of both programs in terms of targeting, quality of care, utilization and out-of-pocket expenditures. This research should lead to informed policy advice on the most cost-effective strategies to target social protection programs, deliver quality care, increase utilization and reduce out-of-pocket expenditures, which ultimately should lead to inclusive growth. The co-incidence of the two programs studied as well as the familiarity of the consortium with the programs and the local situation presents a rare opportunity for a comparison in terms of inclusive growth indicators.