Encouraging maternal health service utilization: An evaluation of the Bangladesh voucher program

Nguyen, Ha; Hatt, Laurel; Islam, Mursaleena; Sloan, Nancy L.; Chowdhury, Jamil; Schmidt, Jean-Olivier; Hossain, Atia; Wang, Hong

doi:10.1016/j.socscimed.2011.11.030

Cited by 96 publications

(114 citation statements)

References 13 publications

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“…A combination of demand and supply side incentives, as seen in Nicaragua, has improved utilization of preventive services among the poor and our study favors a combined approach (28). In remote rural settings measures are needed at facilitating transport access and a number of measures have been identified including community revolving funds for transport, transporter-community links facilitated by NGOs, and transport vouchers (29)(30)(31). BCC has proved to be effective for birth preparedness and newborn care (32), and in this case calls for inclusion of husbands and inlaws.…”

Section: Discussionmentioning

confidence: 78%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong communitybased behavior change strategies. Implications for policy makers• Contracting out public health facilities can be an effective strategy to improve service delivery for Maternal and Neonatal Health (MNH), however, not sufficient to improve the service utilization. • With poor physical and financial access to health facilities in rural settings, transportation and financial safety nets need to be established. • Cultural and customary trends strongly influence decision-making for MNH services utilization. Therefore, community-based behavior change strategies targeting mothers, spouses and mother-in-laws seem crucial.

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Section: Discussionmentioning

confidence: 78%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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“…29 The scheme costs the funders US $41 per voucher distributed. 48 The vouchers entitle the bearer to free antenatal care, post-partum care and skilled birth attendance (at home or in a facility) ( Table 3). 1 In addition to the voucher, the scheme includes a cash incentive for skilled birth attendance, transport costs, a gift package including food, and a cash incentive to providers to offer free services.…”

Section: Bangladeshmentioning

confidence: 99%

“…1,8 In a recent matched comparison study (the strongest study design of any evaluation in the region so far), the likelihood of women having an institutional delivery had increased by almost twofold. 48 At the same time, studies report women beneficiaries' satisfaction with the scheme 29 and increased equity in access for poor women. 8 Despite these considerable successes, the scheme has encountered a number of difficulties, including delays in the release of voucher funds, and confusion over beneficiary selection criteria, both of which are likely to impact on uptake of the scheme.…”

Section: Bangladeshmentioning

confidence: 99%

“…29 In Bangladesh, the scheme remunerates providers for caesarean sections, and reports suggest an increase in surgical deliveries, but it is unclear if this is due to the scheme and/or other factors. 1,48 Recent data reveal that out-of-pocket expenditure persists for women beneficiaries of the scheme, indicating that the scheme has not eliminated financial barriers to maternal health care. 48 Finally, questions remain over the capacity of government facilities to cope with the scheme in view of rapid increases in utilisation.…”

Section: Bangladeshmentioning

confidence: 99%

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Improving access to maternity services: an overview of cash transfer and voucher schemes in South Asia

Jehan¹,

Sidney

Smith

et al. 2012

Reproductive Health Matters

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“…Much of this literature has focused on demand-side initiatives such as conditional cash transfers (Lim et al 2010;Powell-Jackson & Hanson 2012), transportation subsidies (Ekirapa- Kiracho et al 2011), voucher schemes (Bellows, Bellows & Warren 2011;Nguyen et al 2012;Obare et al 2013), and negative incentives or penalties (Godlonton & Okeke 2015). 5 Supply-side studies are considerably less common (Kumar & Dansereau 2014).…”

Section: Introductionmentioning

confidence: 99%

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

Okeke¹,

Glick²,

Abubakar³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report SummaryLimited availability of skilled providers, particularly in rural areas, is thought to be an important constraint to increasing rates of use of maternal and child health services in low-and middle-income countries. There are, however, few well-identified studies of the relationship between the supply of skilled workers and outcomes. In this project, we studied the effects of a government program in Nigeria that sought to alleviate supply-side constraints by deploying skilled midwives to primary health facilities in rural communities, to provide round-the-clock access to skilled care.We evaluate the impact of the Midwives Service Scheme (MSS), a government program introduced in 2009 to increase access to skilled care in underserved rural areas in Nigeria. At rollout, the MSS deployed nearly 2,500 midwives to 652 primary health care centers across 36 states. To evaluate the impact of the program, we surveyed 7,104 women with a birth within the preceding five years in 386 communities across 12 states. The intervention group consisted of communities that participated in the initial rollout; the comparison group consisted of communities that would receive the program approximately three years later. To understand implementation challenges and contextualize the quantitative results, we carried out a nested qualitative study in three states, consisting of in-depth interviews and focus group discussions with policymakers, providers, childbearing women, and community stakeholder groups.Overall, we found that the program's effects were smaller than anticipated. The main effect was a 7.3-percentage-point increase in antenatal care use in program clinics (about 12 percent relative to baseline levels) and a 5-percentage-point increase in overall use of antenatal care (6 percent relative to baseline levels) within the first year of the program. We found suggestive but not conclusive evidence of a small increase in skilled birth attendance, but this was confined to the south, where there were fewer challenges with midwife retention. We did not find any significant improvements in postnatal visits or child immunizations. Given this, it is not surprising that we did not find any evidence of improvements in maternal and child health.Our data allow us to shed some light on why ...

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Encouraging maternal health service utilization: An evaluation of the Bangladesh voucher program

Cited by 96 publications

References 13 publications

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Improving access to maternity services: an overview of cash transfer and voucher schemes in South Asia

Better Obstetrics in Rural Nigeria study: evaluating the Nigerian Midwives Service Scheme

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