Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study

Meuwissen, L. E.; Gorter, Anna; Knottnerus, André

doi:10.1016/j.jadohealth.2005.01.009

Cited by 57 publications

(66 citation statements)

References 19 publications

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“…In addition to policies and procedures that ensure services are free or affordable, innovative financing mechanisms, such as voucher schemes, may increase demand and uptake of SRH services by adolescents [33]. Promising findings from studies in Latin America have suggested that combining such interventions with provider incentives can increase access and improve quality of care [34,35]. …”

Section: Discussionmentioning

confidence: 99%

“Be kind to young people so they feel at home”: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu

Kennedy

Bulu

Harris

et al. 2013

BMC Health Serv Res

123

169

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BackgroundSexual activity during adolescence is common in Vanuatu, however many adolescents lack access to sexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH. There is limited peer-reviewed research describing adolescents’ SRH service delivery preferences in Vanuatu to inform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents from accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by adolescents.MethodsSixty-six focus group discussions were conducted with 341 male and female adolescents aged 15–19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with policymakers and service providers. Data were analysed using thematic analysis.ResultsSocio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors preventing adolescents from accessing services. These contributed to adolescents’ own fear and shame, judgmental attitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality and privacy, costs, and adolescents’ lack of SRH knowledge were also important barriers. Adolescents and service providers identified opportunities to make existing services more youth-friendly. The most important feature of a youth-friendly health service described by adolescents was a friendly service provider. Free or affordable services, reliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural norms and community knowledge and attitudes was also highlighted.ConclusionsThere are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youth-friendly, such as improving service provider training. Investment is also required in strategies that aim to create a more supportive environment for adolescent SRH.

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Section: Discussionmentioning

confidence: 99%

“Be kind to young people so they feel at home”: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu

Kennedy

Bulu

Harris

et al. 2013

BMC Health Serv Res

123

169

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show abstract

“…Initial findings from the few assessments of reproductive health voucher programs suggest that, if implemented well, they have the potential to achieve the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality [4,5]. There is, however, a paucity of evidence describing how: (1) the voucher programs function in different settings, for various reproductive health services delivered through public, for-profit or non-profit organizations; and (2) the voucher program affects the operational efficiency and business model used by service delivery organizations and individual providers.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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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.

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“…Encouraged by its success with an education voucher scheme for girls, Bangladesh is keen to introduce vouchers in health specifically to reduce maternal mortality (Islam, 2003). Nicaragua has implemented highly successful voucher schemes to provide specific services to underserved populations, such as the STI/HIV/AIDS services for sex workers (Borghi et al, 2005;Gorter et al, 2006;McKay et al, 2006), the sexual and reproductive health care scheme for adolescents (Meuwissen et al, 2006) and cervical cancer screening for older rural women (Howe et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Improving access to reproductive and child health services in developing countries: are competitive voucher schemes an option?

Bhatia

Gorter

2007

J of Intl Development

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Reducing maternal and child mortality is an important goal of the Millennium declaration and a major concern for policy makers in developing countries. One of the important barriers to reducing maternal mortality is the low utilisation of maternal health services provided by the public health system through it supply side mechanisms. Demand side financing is increasingly being proposed as one of the options to increase access to reproductive and child health services and is generating great interest in a number of developing countries. Demand side financing not only promotes equity through improved access and better targeting of subsidies, but also provides incentives for efficiency and provider choice by involving the private sector. This paper discusses the concept of demand side financing, and analyses its strengths and limitations. Copyright © 2007 John Wiley & Sons, Ltd.

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Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi-experimental intervention study

Cited by 57 publications

References 19 publications

“Be kind to young people so they feel at home”: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu

“Be kind to young people so they feel at home”: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu

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

Improving access to reproductive and child health services in developing countries: are competitive voucher schemes an option?

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