Community-level impact of the reproductive health vouchers programme on service utilization in Kenya

Abstract

This paper examines community-level association between exposure to the reproductive health vouchers programme in Kenya and utilization of services. The data are from a household survey conducted among 2527 women (15–49 years) from voucher and comparable non-voucher sites. Analysis entails cross-tabulations with Chi-square tests and significant tests of proportions as well as estimation of multi-level logit models to predict service utilization by exposure to the programme. The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all. There were, however, no significant differences in the timing of first trimester utilization of antenatal care (ANC) and making four or more ANC visits by exposure to the programme. In addition, poor women were significantly less likely to have used safe motherhood services (health facility delivery, skilled delivery care and postnatal care) compared with their non-poor counterparts regardless of exposure to the programme. Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all. The findings suggest that the programme is associated with increased health facility deliveries and skilled delivery care especially among poor women. However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.

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

“…Evidence from other settings suggests that demand-side factors are substantively important (Obare et al 2013;Powell-Jackson & Hanson 2012). 26 We found some evidence that low perceived value attached to MCH services by households hindered uptake.…”

“…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).…”

Sexual and reproductive health and rights in changing health systems

“…An important concern is that services expansion in the name of UHC might actually worsen quality of services, or cut corners on medical ethics. For instance, there is a concern about some of the consequences of the growing popularity of demand-side financing, now spreading rapidly from Latin America (Bradshaw, 2008;Lomelí, 2008) to Asia (Ahmed & Khan, 2011;Powell-Jackson et al, 2009) and Africa Obare et al, 2013). Effective demand-side financing can significantly increase the demand for services as it did under various programmes in Latin America (Frenk, González-Pier, Gómez-Dantés, Lezana, & Knaul, 2006;Lomelí, 2008) and more recently in India under the Janani Suraksha Yojana programme (Lim et al, 2010).…”

Effects of Decentralized Health-Care Financing on Maternal Care in Indonesia

“…While studies have found generally positive effects of vouchers on institutional deliveries, these schemes appear to be less successful in promoting and improving antenatal care (see e.g. Achmed and Khan, 2011;Bellows et al, 2011;Obare et al, 2013;Van de Poel et al, 2014). Explanations for this failure of vouchers to enhance the uptake of maternal care services include lack of information and awareness of the voucher scheme and a lack of trust that the services are indeed delivered free of charge (see Obare et al, 2013).…”

“…Achmed and Khan, 2011;Bellows et al, 2011;Obare et al, 2013;Van de Poel et al, 2014). Explanations for this failure of vouchers to enhance the uptake of maternal care services include lack of information and awareness of the voucher scheme and a lack of trust that the services are indeed delivered free of charge (see Obare et al, 2013). Other countries, such as Afghanistan, India and Nepal, have introduced conditional cash transfer programs to influence maternal health related behaviors.…”