Assessing the population-level impact of vouchers on access to health facility delivery for women in Kenya

Obare, Francis; Warren, Charlotte E.; Abuya, Timothy; Askew, Ian; Bellows, Benjamin

doi:10.1016/j.socscimed.2013.12.007

Cited by 35 publications

(32 citation statements)

References 18 publications

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“…[48], and Obare et al . [57], respectively). A before-and-after study without controls (n = 850 women) of a pilot voucher scheme in Bangladesh found an increase in births in healthcare facilities compared to baseline [49], and two cross-sectional studies (n = 3,600 women and n = 2,208 women) of Bangladesh’s Maternal Health Voucher Scheme found evidence of an increase compared to in intervention areas or among recipients [46,48].…”

Section: Resultsmentioning

confidence: 99%

“…Three before-and-after studies (n = 6,027 women, n = 4,362 women and n = 627 women) found that the Vouchers for Health programme in Kenya increased the proportion of births in healthcare facilities in intervention areas, with women who received vouchers more likely to give birth in healthcare facilities in intervention areas [55–57]. Similarly, two before-and-after studies (n = 4,051 women and n = 1,423 women) of pilot voucher programmes in Pakistan also found births in healthcare facilities increased among recipients and more generally in intervention areas compared to areas assessed before roll out of the intervention [60,61].…”

Section: Resultsmentioning

confidence: 99%

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The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

et al. 2017

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BackgroundCash transfers and vouchers are forms of ‘demand-side financing’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.MethodsThis systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637).ResultsData from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes.ConclusionFuture research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

et al. 2017

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“…The larger study used a pretest and posttest design with a comparison group. Preintervention (pre‐FMS policy) data were from a 2012 study that evaluated the effect of the reproductive health vouchers program in Kenya on health outcomes by comparing communities in voucher and comparable nonvoucher sites . The postintervention data were collected in the same communities included in the 2012 study and involved both quantitative and qualitative components.…”

Section: Methodsmentioning

confidence: 99%

“…Following the pilot, the program was expanded to one additional county (Kilifi) as well as to additional facilities in the pilot counties, and implementation continued until late 2016. The results of this initiative indicated promising opportunities for improving access, coverage, and quality for targeted low‐income beneficiaries …”

Section: Introductionmentioning

confidence: 99%

Stakeholder perspectives regarding transfer of free maternity services to National Health Insurance Fund in Kenya: Implications for universal health coverage

Abuya

Obare

Matanda

et al. 2018

Health Planning & Management

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“…For example; researchers have assessed the population level impact of vouchers on health facility delivery [15] and evaluated the community level impact of vouchers service utilization which showed that the voucher scheme helped in reducing the proportion of women in the community who paid out-of- pocket for safe motherhood services [16] Additionally, the quasi experimental evaluation of the voucher scheme showed the group level causal relationship between expansions of the Kenyan voucher mechanism and changes in the quality of post natal care [17]. On the other hand, other researcher have described the community experiences and perception of the clients on the voucher schemes [18] and a longitudinal analysis on facility based delivery in slums [19].…”

Section: Introductionmentioning

confidence: 99%

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya

Oyugi

Kioko

Kaboro

et al. 2017

BMC Health Serv Res

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BackgroundThe study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility.MethodsThe study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17.ResultsAll the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R2 value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning.ConclusionThe study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.

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Assessing the population-level impact of vouchers on access to health facility delivery for women in Kenya

Cited by 35 publications

References 18 publications

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

Stakeholder perspectives regarding transfer of free maternity services to National Health Insurance Fund in Kenya: Implications for universal health coverage

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya

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