Evaluation of the impact of the voucher program for improving maternal health behavior and status in Bangladesh

Talukder, Md. Noorunnabi; Rob, Ubaidur; Musa, Syed Abu Jafar; Bajracharya, Ashish; Keya, Kaji Tamanna; Noor, Forhana Rahman; Jahan, Eshita; Hossain, Md. Irfan; Saha, Jyotirmoy; Bellows, Benjamin

doi:10.31899/rh10.1000

Cited by 11 publications

(17 citation statements)

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“…The voucher scheme targets socioeconomically disadvantaged mothers and provides them with three ANC visits, a SBA for home- or facility-based delivery, one post-natal care visit, and cash remunerations for travel expenses [25]. Past evaluations found the voucher scheme to reduce out-of-pocket expenditures, decrease the equity gap and increase ANC uptake, SBA use, and institutional delivery within select voucher areas [28, 29].…”

Section: Discussionmentioning

confidence: 99%

Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis

et al. 2019

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Background With Bangladesh’s adoption of the third Sustainable Development Goal to reduce maternal mortality, the impetus for Bangladesh to continue to improve uptake of maternal healthcare is strong. Methods Using a propensity-score matched analysis, the present study utilized data from the 2014 Bangladesh Demographic Health survey to examine the impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery. Results The results revealed a significant and positive impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery after matching treated and untreated mothers on included socio-demographic characteristics. Conclusions Implementation of policies to provide at least four antenatal care visits may serve as an effective strategy to increase SBA use and institutional delivery in Bangladesh, which could contribute to the reduction of maternal mortality. Electronic supplementary material The online version of this article (10.1186/s12889-019-6945-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis

et al. 2019

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“…In Tanzania, a program that facilitates transportation costs via mobile phone significantly increased access to fistula repair services in referral hospitals [ 36 ]. In Bangladesh, free maternity care and transportation vouchers increased women’s use of public health centers [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“Poverty is the big thing”: exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda

Keya

Sripad

Nwala

et al. 2018

Int J Equity Health

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BackgroundWomen living with obstetric fistula often live in poverty and in remote areas far from hospitals offering surgical repair. These women and their families face a range of costs while accessing fistula repair, some of which include: management of their condition, lost productivity and time, and transport to facilities. This study explores, through women’s, communities’, and providers’ perspectives, the financial, transport, and opportunity cost barriers and enabling factors for seeking repair services.MethodsA qualitative approach was applied in Kano and Ebonyi in Nigeria and Hoima and Masaka in Uganda. Between June and December 2015, the study team conducted in-depth interviews (IDIs) with women affected by fistula (n = 52) – including those awaiting repair, living with fistula, and after repair, and their spouses and other family members (n = 17), along with health service providers involved in fistula repair and counseling (n = 38). Focus group discussions (FGDs) with male and female community stakeholders (n = 8) and post-repair clients (n = 6) were also conducted.ResultsWomen’s experiences indicate the obstetric fistula results in a combined set of costs associated with delivery, repair, transportation, lost income, and companion expenses that are often limiting. Medical and non-medical ancillary costs such as food, medications, and water are not borne evenly among all fistula care centers or camps due to funding shortages. In Uganda, experienced transport costs indicate that women spend Ugandan Shilling (UGX) 10,000 to 90,000 (US$3.00-US$25.00) for two people for a single trip to a camp (client and her caregiver), while Nigerian women (Kano) spent Naira 250 to 2000 (US$0.80-US$6.41) for transportation. Factors that influence women’s and families’ ability to cover costs of fistula care access include education and vocational skills, community savings mechanisms, available resources in repair centers, client counseling, and subsidized care and transportation.ConclusionsThe concentration of women in poverty and the perceived and actual out of pocket costs associated with fistula repair speak to an inability to prioritize accessing fistula treatment over household expenditures. Findings recommend innovative approaches to financial assistance, transport, information of the available repair centers, rehabilitation, and reintegration in overcoming cost barriers.

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“…A secondary objective was to determine whether the voucher programme improved service quality by verifying service delivery through reimbursements to providers. Country-specific study protocols that detail data collection processes have been previously published 20–22. As the study relied on extant data, indicators were not identified a priori.…”

Section: Methodsmentioning

confidence: 99%

“…Voucher facilities were compared with a sample of non-accredited (control) facilities from the same/similar districts. To reduce the potential for selection bias related to facility enrolment, pairwise matching was also used to match facilities on factors hypothesised to influence provider behaviour a priori, including profile of clientele, location and fees charged, type of practice, and skills mix 21 22. In total, 3169 women were interviewed and observed for ANC (n=1036 in Bangladesh, 957 in Cambodia and 1176 in Kenya) and 2462 for PNC (n=208 in Bangladesh, 635 in Cambodia and 1619 in Kenya).…”

Section: Methodsmentioning

confidence: 99%

Validating women’s reports of antenatal and postnatal care received in Bangladesh, Cambodia and Kenya

et al. 2020

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BackgroundGlobal indicators for monitoring progress in maternal and newborn health have tended to rely on contact coverage indicators rather than the content of services received. As part of the effort to improve measurement of progress in maternal and newborn health, this study examines how accurately women can report on information and health interventions received during an antenatal or postnatal health consultation at health facilities in Bangladesh, Cambodia and Kenya.MethodsWe conducted secondary analysis of matched observation and client interview data to compare women’s reports of care received at exit interview with observation by a trained third-party observer. We assessed indicator accuracy by calculating sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and inflation factor (IF). Indicators considered to have both high individual accuracy (an AUC value of 0.70 or greater) and low population-level bias (0.75<IF<1.25) were considered to have acceptable validity. In addition, we considered the number of countries where both validation criteria were met.ResultsFor indicators of antenatal care, we found 16 of 18 indicators in Bangladesh, 3 of 6 in Cambodia and 3 of 8 in Kenya met both validation criteria. For postnatal care, we found evidence of acceptable validity for 6 of 8 indicators in Bangladesh, 5 of 14 in Cambodia and 3 of 16 in Kenya. In general, we documented higher validity for indicators related to concrete, observable actions, as opposed to information or advice given. Women were more likely to recall care received for themselves, rather than for their newborn.ConclusionsWomen reported accurately on multiple aspects of antenatal and postnatal care. While we describe broad patterns in the types of indicators likely to be recalled with accuracy, differences by setting warrant further investigation. Findings inform efforts to better monitor the coverage and quality of maternal and newborn health interventions.

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Evaluation of the impact of the voucher program for improving maternal health behavior and status in Bangladesh

Cited by 11 publications

References 10 publications

Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis

Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis

“Poverty is the big thing”: exploring financial, transportation, and opportunity costs associated with fistula management and repair in Nigeria and Uganda

Validating women’s reports of antenatal and postnatal care received in Bangladesh, Cambodia and Kenya

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