Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya

Abstract

AbtsractBackgroundAlternatives to the traditional 'supply-side' approach to financing service delivery are being explored. These strategies are termed results-based finance, demand-side health financing or output-based aid which includes a range of interventions that channel government or donor subsidies to the user rather than the provider. Initial pilot assessments of reproductive health voucher programs suggest that, they can increase access and use, reducing inequities and enhancing program efficiency and service quality. However, there is a paucity of evidence describing how the programs function in different settings, for various reproductive health services. Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the 'voucher and accreditation' approaches to improving the reproductive health of low income women in Kenya.Methods/DesignA quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status and reducing inequities at the population level; and assessing the effect of vouchers on increasing access to, and quality of, and reducing inequities in the use of selected reproductive health services. The study comprises of four populations: facilities, providers, women of reproductive health age using facilities and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in samples of health facilities - public, private and faith-based in: three districts; Kisumu, Kiambu, Kitui and two informal settlements in Nairobi which are accredited to provide maternal and newborn health and family planning services to women holding vouchers for the services; and compared with a matched sample of non-accredited facilities. Health facility assessments (HFA) will be conducted at two stages to track temporal changes in quality of care and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3000 respondents will also be carried out in areas where vouchers are distributed and similar locations where vouchers are not distributed.

Community experiences and perceptions of reproductive health vouchers in Kenya

“…Interviews were conducted in English, Kiswahili (the national language) or the local languages. A full description of the household survey design has been published elsewhere [20]. The data from the PDAs were downloaded into Access database and exported into Stata 10 for analysis using frequency distributions and cross-tabulations.…”

The impact of vouchers on the use and quality of health care in developing countries: A systematic review

“…At present, there is a multi-site voucher programme evaluation under way on at least three voucher programmes that should be completed in the next two years (Bellows et al 2011b, Ubaidur et al 2011, Warren et al 2011. These findings may change whether voucher programmes are considered effective and including this information will be essential in understanding the extent to which voucher programmes are successful in achieving their goals.…”

“…The overall findings on health impact indicate that vouchers do not have an impact on the health of populations; however, this conclusion was found to be unstable and one positive finding on health outcomes would change this conclusion to robust evidence. Future evidence from voucher programmes currently being evaluated (Bellows et al 2011b, Ubaidur et al 2011, Warren et al 2011) may change the balance of this assessment, either from more definitive evidence of no evidence of an effect or one of modest/robust effects. The results of this review can offer recommendations for future evaluations in terms of the type of evidence needed to better understand the impact on health of voucher programmes.…”

“…The original intent for assessing quality and risk of bias was to rely on the guidelines recommended by the Cochrane Collaboration for assessing study quality using the CONSORT checklist (Schulz et al 2010) and the Newcastle-Ottawa Scale (Wells et al 2010). However, we found very few studies that could be adequately assessed using these tools and therefore adapted these tools and others identified in the literature to better serve the purposes of this review.…”

“…The adapted tool utilised for this review, the 'Confidence in Findings Assessment' (CFA) tool, is described in more detail below. The foundation for the new tool was the Newcastle-Ottawa scale (Wells et al 2010) and was augmented based on suggestions in the literature of steps to take when assessing the quality of studies, particularly relying on an article by Fowkes and Fulton (1991).…”