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Nabhan A, Kabra R, Ashraf A, Elghamry F, Kiarie J. Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review. BMC Womens Health 2023; 23:574. [PMID: 37932747 PMCID: PMC10629088 DOI: 10.1186/s12905-023-02735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Demand generation aims to increase clients' desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning. METHODS We searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings. RESULTS Forty-six studies (published 1990-2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services. CONCLUSIONS Demand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization. TRIAL REGISTRATION Systematic review registration: Center for Open Science, osf.io/286j5.
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Affiliation(s)
- Ashraf Nabhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Ramses Street, Cairo, Egypt.
| | - Rita Kabra
- Department of Sexual and Reproductive Health including UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Alyaa Ashraf
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - James Kiarie
- Department of Sexual and Reproductive Health including UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
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Nuwamanya E, Babigumira JB, Svensson M. Cost-effectiveness of increased contraceptive coverage using family planning benefits cards compared with the standard of care for young women in Uganda. Contracept Reprod Med 2023; 8:21. [PMID: 36782307 PMCID: PMC9926799 DOI: 10.1186/s40834-022-00206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/04/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Uganda has a high population growth rate of 3%, partly due to limited access to and low usage of contraception. This study assessed the cost-effectiveness of the family planning benefits cards (FPBC) program compared to standard of care (SOC). The FPBC program was initiated to increase access to modern contraception among young women in slums in Kampala, Uganda. METHODS We developed a decision-analytic model (decision tree) and parameterized it using primary intervention data together with previously published data. In the base case, a sexually active woman from an urban slum, aged 18 to 30 years, was modelled over a one-year time horizon from both the modified societal and provider perspectives. The main model outcomes included the probability of unintended conception, costs, and incremental cost-effectiveness ratio (ICER) in terms of cost per unwanted pregnancy averted. Both deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the modelling results. All costs were reported in 2022 US dollars, and analyses were conducted in Microsoft Excel. RESULTS In the base case analysis, the FPBC was superior to the SOC in outcomes. The probability of conception was lower in the FPBC than in the SOC (0.20 vs. 0.44). The average societal and provider costs were higher in the FPBC than in the SOC, i.e., $195 vs. $164 and $193 vs. $163, respectively. The ICER comparing the FPBC to the SOC was $125 per percentage reduction in the probability of unwanted conception from the societal perspective and $121 from the provider perspective. The results were robust to sensitivity analyses. CONCLUSION Given Uganda's GDP per capita of $1046 in 2022, the FPBC is highly cost-effective compared to the SOC in reducing unintended pregnancies among young women in low-income settings. It can even get cheaper in the long run due to the low marginal costs of deploying additional FPBCs. TRIAL REGISTRATION MUREC1/7 No. 10/05-17. Registered on July 19, 2017.
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Affiliation(s)
- Elly Nuwamanya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P. O Box 22418, Kampala, 40530, Uganda. .,GHE Consulting, P.O Box 27011, Kampala, Uganda. .,Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, P. O Box 414, 40530, Gothenburg, Sweden.
| | | | - Mikael Svensson
- grid.8761.80000 0000 9919 9582Department of Community Medicine and Public Health, Sahlgrenska Academy, University of Gothenburg, P. O Box 414, 40530 Gothenburg, Sweden
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Yam CHK, Yeoh EK, Wong ELY, Lai AHY, Ip EMY, Chow TY, Wang K. Experience of a demand-side subsidy scheme for residential long-term care: perspectives of elderly and their carers. BMC Geriatr 2023; 23:12. [PMID: 36611138 PMCID: PMC9824965 DOI: 10.1186/s12877-022-03692-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Vouchers, which are demand-side subsidies to targeted groups, are a type of consumer-led near-cash social transfer for specified benefits that have been used in education, health and other sectors. To provide better access to residential care services and an additional choice for elderly people in need, a novel means-tested residential care service voucher has been introduced in Hong Kong for elderly people to purchase places in the private sector to enable consumer-directed care. The objectives of this paper are to analyze the perspectives of voucher users and their carers toward the voucher scheme and to identify key elements in the design that will contribute to meeting the scheme's objectives. METHODS An exploratory sequential mixed method design was adopted with initial explorative qualitative data collection of the perspectives of elderly people and their carers (Phase 1), which informed the design of the subsequent questionnaire survey (Phase 2). Thirty carers in 5 focus groups and 20 individual interviews with elderly people were conducted between April and May 2018. A total of 401 respondents (373 carers and 28 elderly people) completed the survey questionnaire. Findings from both phases were integrated both narratively and via a joint display. RESULTS Five key themes summarized the features in two main elements of the design and implementation of the voucher scheme: awareness, meaning that inadequate knowledge and understanding of voucher schemes hinder participation; service needs and types, indicating that the urgent need for residential care services is the key reason for participation; shared responsibility, meaning that a high copayment level discourages participation; choice and flexibility, reflecting appreciation of the additional choices provided by voucher schemes although the availability of residential care beds limits choices; and service quality, indicating mixed perceptions of service quality and the impact of the voucher scheme. Voucher users believe that the voucher scheme is more helpful for relieving the financial burden (98.7%), reducing carers' stress (97.0%) and reducing the waiting time for subsidized homes for elderly people (89.0%) than for increasing choice and flexibility (78.1%) and improving service quality (62.1%). CONCLUSIONS This study demonstrates how the design of a voucher scheme affects its take-up by targeted beneficiaries. When a voucher scheme is implemented in a long-term care system, it must consider the congruence with existing policies in long-term care provision and financing. The voucher scheme in Hong Kong has been able to generate the utilization of nonsubsidized places in homes for elderly people that were underutilized, but its effectiveness is limited by inadequate knowledge and understanding of the voucher scheme and the availability of residential care places. Giving the purchasing power and choice of providers to beneficiaries has the potential to enhance the quality of services, which will contribute to meeting the objectives. The study findings carry significant implications for long-term care policies and provide insights into the key features of the voucher scheme for residential care services and how to best design and implement a voucher scheme for elderly people in the context of policy objectives and a long-term care policy.
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Affiliation(s)
- Carrie Ho-Kwan Yam
- grid.10784.3a0000 0004 1937 0482Centre for Health Systems and Policy Research, The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 418, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China
| | - Eng-Kiong Yeoh
- grid.10784.3a0000 0004 1937 0482Centre for Health Systems and Policy Research, The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 418, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China
| | - Eliza Lai-Yi Wong
- grid.10784.3a0000 0004 1937 0482Centre for Health Systems and Policy Research, The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 418, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China
| | - Angel Hor-Yan Lai
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Ethan Ming-Yin Ip
- grid.10784.3a0000 0004 1937 0482Centre for Health Systems and Policy Research, The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 418, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China
| | - Tsz-Yu Chow
- grid.10784.3a0000 0004 1937 0482Centre for Health Systems and Policy Research, The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 418, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China
| | - Kailu Wang
- grid.10784.3a0000 0004 1937 0482Centre for Health Systems and Policy Research, The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 418, School of Public Health, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China
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Ganle JK, Baatiema L, Ayamah P, Ofori CAE, Ameyaw EK, Seidu AA, Ankomah A. Family planning for urban slums in low- and middle-income countries: a scoping review of interventions/service delivery models and their impact. Int J Equity Health 2021; 20:186. [PMID: 34412647 PMCID: PMC8375135 DOI: 10.1186/s12939-021-01518-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. Methods We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. Results The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls’ club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. Conclusions This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01518-y.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13 Legon, Accra, Ghana.
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Ravaoarisoa L, Razafimahatratra MJJ, Rakotondratsara MA, Gaspard N, Ratsimbazafy MR, Rafamantanantsoa JF, Ramanantsoa V, Schaaf M, Midy AC, Casey SE. Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar. Sex Reprod Health Matters 2021; 28:1838053. [PMID: 33054631 PMCID: PMC7887949 DOI: 10.1080/26410397.2020.1838053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Madagascar's health system is highly dependent on donor funding, especially from the United States (US), and relies on a few nongovernmental organisations (NGOs) to provide contraceptive services in remote areas of the country. The Trump administration reinstated and expanded the Global Gag Rule (GGR) in 2017; this policy requires non-US NGOs receiving US global health funding to certify that neither they nor their sub-grantees will provide, counsel or refer for abortion as a method of family planning. Evidence of the impact of the GGR in a country with restrictive abortion laws, like Madagascar - which has no explicit exception to save the woman's life - is limited. Researchers conducted semi-structured interviews with 259 representatives of the Ministry of Health and NGOs, public and private health providers, community health workers and contraceptive clients in Antananarivo and eight districts between May 2019 and March 2020. Interviews highlighted the impact of the GGR on NGOs that did not certify the policy and lost their US funding. This reduction in funding led to fewer contraceptive service delivery points, including mobile outreach services, a critical component of care in rural areas. Public and private health providers reported increased contraceptive stockouts and fees charged to clients. Although the GGR is ostensibly about abortion, it has reduced access to contraception for the Malagasy population. This is one of few studies to directly document the impact on women who themselves described their increased difficulties obtaining contraception ultimately resulting in discontinuation of contraceptive use, unintended pregnancies and unsafe abortions.
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Affiliation(s)
| | | | | | - Naomi Gaspard
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | | | | | - Anne-Caroline Midy
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sara E Casey
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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6
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Mahmood SS, Amos M, Hoque S, Mia MN, Chowdhury AH, Hanifi SMA, Iqbal M, Stones W, Pallikadavath S, Bhuiya A. Does healthcare voucher provision improve utilisation in the continuum of maternal care for poor pregnant women? Experience from Bangladesh. Glob Health Action 2020; 12:1701324. [PMID: 31825301 PMCID: PMC6913632 DOI: 10.1080/16549716.2019.1701324] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh. Following a steep decline in the maternal mortality ratio over the past decade in Bangladesh, progress has plateaued at 196/100,000 live births. A voucher scheme was initiated in 2007 to reduce financial, geographical and institutional barriers to access for the poorest. Objective: The current paper reports the effect of vouchers on the use of continuum of maternal care. Methods: Cross-sectional surveys were carried out in the Chattogram and Sylhet divisions of Bangladesh in 2017 among 2400 women with children aged 0–23 months. Using Cluster analysis utilisation groups for antenatal care, facility delivery and postnatal care were formed. Clusters were regressed on voucher receipt to identify the underlying relationship between voucher receipt and utilisation of care while controlling for possible confounders. Results: Four clusters with varying levels of utilisation were identified. A significantly higher proportion of voucher-recipients belonged to the high-utilisation cluster compared to non-voucher recipients (43.5% vs. 15.4%). For the poor voucher recipients, the probability of belonging to the high-utilisation cluster was higher compared to poor non-voucher recipients (33.3% vs. 6.8%) and the probability of being in the low-utilisation cluster was lower than poor non-voucher recipients (13.3% vs. 55.4%). Conclusion: The voucher programme enhanced uptake of the complete continuum of maternal care and the benefits extended to the most vulnerable women. However, a lack of continued transition through the continuum of maternal care was identified. This insight can assist in designing effective interventions to prevent intermittent or interrupted care-seeking. Programmes that improve access to quality healthcare in pregnancy, childbirth and the postnatal period can have wide-ranging benefits. A coherent continuum-based approach to understanding maternal care-seeking behaviour is thus expected to have a greater impact on maternal, newborn and child health outcomes.
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Affiliation(s)
| | - Mark Amos
- Portsmouth Brawajaya Centre for Global Health, University of Portsmouth, Portsmouth, UK
| | - Shahidul Hoque
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Mohammad Nahid Mia
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Asiful Haidar Chowdhury
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.,IMPACT study, ARK Foundation, Dhaka, Bangladesh
| | | | - Mohammad Iqbal
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - William Stones
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Abbas Bhuiya
- Portsmouth Brawajaya Centre for Global Health, University of Portsmouth, Portsmouth, UK
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Yeoh EK, Yam CHK, Chong KC, Chow TY, Fung VLH, Wong ELY, Griffiths SM. An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey cohort in Hong Kong. Health Policy 2019; 124:189-198. [PMID: 31898988 DOI: 10.1016/j.healthpol.2019.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
To incentivize private primary care utilization and reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been implemented to provide a voucher entitlement to entire older resident population for subsidising their purchase of unspecified primary healthcare services in the private sector. Our study assessed whether voucher usage is associated with reduced utilization of public healthcare services. We retrieved the public healthcare services utilization and voucher transaction data of a survey cohort of 551 participants, who were age eligible for the scheme since 2009, over the period 2009-2015. Our results showed that voucher usage was not associated with reduced utilization of public healthcare services and has encouraged dual utilization of public and private healthcare. It may be due to a generated supply-induced demand and price inflation. The finding suggests the voucher is specifically designed to address the health systems issues to achieve the effective policy objectives. Defining the specific services to be provided and the prices at which they should be offered based on the needs of specified populations is a fundamental design parameter which needs to be incorporated. The alternatives of whether primary care services should be expanded and provided in the public sector or purchased using supply/demand side instruments should be considered taking the context and goals of the health system into account.
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Affiliation(s)
- Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Carrie H K Yam
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Ka-Chun Chong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Tsz-Yu Chow
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Valerie L H Fung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Sian M Griffiths
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
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Yam CHK, Wong ELY, Fung VLH, Griffiths SM, Yeoh EK. What is the long term impact of voucher scheme on primary care? Findings from a repeated cross sectional study using propensity score matching. BMC Health Serv Res 2019; 19:875. [PMID: 31752826 PMCID: PMC6873583 DOI: 10.1186/s12913-019-4707-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/04/2019] [Indexed: 11/26/2022] Open
Abstract
Background Vouchers are increasingly used as a demand-side subsidy to reduce financial hardship and improve quality of services. Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government since 2009 to provide subsidy to elderly aged 65 and above to visit ten different types of private primary care providers for curative, preventive and chronic disease management. Several enhancements have been made over the past few years. This paper (as part of an evaluation study of this unique healthcare voucher scheme) aims to assess the long term impact of the voucher scheme in encouraging the use of primary care services. Methods Two rounds of cross-sectional survey among elderly in Hong Kong were conducted in 2010 and 2016. Propensity score matching and analysis were used to compare changes in perception and usage of vouchers over time. Results 61.5% of respondents in 2016 agreed “the scheme encourages me to use more private primary care services”, a significant increase from 36.2% in 2010. Among those who agreed in 2016, the majority thought the voucher scheme would encourage them to use acute services (90.3%) in the private sector, rather than preventive care (40.3%) and chronic disease management (12.2%). Respondents also reported that their current usual choice of care was visiting “both public and private doctors” (61.9%), representing a significant increase (up from 48.4%) prior to their use of voucher. Conclusions The voucher scheme has encouraged the use of more private care services, particularly acute services rather than disease prevention or management of chronic disease. However, there needs to be caution that the untargeted and open-ended nature of voucher scheme could result in supply-induced demand which would affect long term financial sustainability. The dual utilization of health services in both the public and private sector may also compromise continuity and quality of care. The design of the voucher needs to be more specific, targeting prevention and chronic disease management rather than unspecified care which is mainly acute and episodic in order to maximize service delivery capacity as a whole for equitable access in universal health coverage and to contribute to a sustainable financing system.
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Affiliation(s)
- Carrie H K Yam
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Valerie L H Fung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Sian M Griffiths
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
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Abstract
Despite impressive progress in increasing contraceptive use in developing countries during recent decades, the uptake has lagged behind in Africa. One of the most critical factors in raising the use of contraception is women's employment status. This study analyzed the link between women's employment and family planning in rural Uganda and addressed shortcomings in the literature by using nationally representative panel data from the 2010 and 2012 rounds of the Uganda National Panel Survey for 800 women aged 15-49 years, and estimating heterogeneous effects for different types of employment and across socio-economic characteristics. Employment was not associated with greater use of modern contraceptives, but off-farm wage-employed women were more likely to use traditional contraception. The correlation of employment was strongest for women who had reached their desired fertility status, but became insignificant for poorer women who lived in remote areas. However, likely due to the ineffectiveness of traditional methods, off-farm wage employment was not associated with greater spacing between births. Our findings implied that providing rural employment opportunities for women is insufficient to increase the uptake of modern contraceptives. To enhance the effectiveness of family planning programs, health-care officers should target off-farm wage-employed women to address their unmet contraceptive needs.
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Affiliation(s)
- Goedele Van den Broeck
- Division of Bio-Economics, Department of Earth and Environmental Sciences, KU Leuven, Leuven, Belgium
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10
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Nuwasiima A, Nuwamanya E, Babigumira JU, Nalwanga R, Asiimwe FT, Babigumira JB. Acceptability and utilization of family planning benefits cards by youth in slums in Kampala, Uganda. Contracept Reprod Med 2019; 4:10. [PMID: 31396395 PMCID: PMC6681485 DOI: 10.1186/s40834-019-0092-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/29/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study was conducted to test the acceptability and utilization of family planning benefits cards (FPBCs) as incentives to increase family planning uptake among youth living in urban slums in Uganda. METHODS We conducted a one-year pilot study with two sub-studies on acceptability and utilization of FPBCs. The acceptability study utilized a quantitative cross-sectional design and was part of a baseline household survey while the utilization study was a primary analysis of claims and clinic data. We performed descriptive analyses and analyses of the association between different variables using binary logistic regression. RESULTS The acceptability study included 280 eligible females. The majority were married (52%), Christian (87%), and aged 20 and above (84%). Acceptability of the program was high (93%). Seventy-two percent of females used the card at least once to access reproductive health services. Twenty-seven percent of female users discontinued family planning and 14% changed family planning methods during the study. Female users of short-term contraceptive methods were 11 times more likely to discontinue use of FPBCs compared to those who used long-term methods (adjusted OR = 10.9, P = 0.011). Participants in professional/managerial employment were 30 times more likely to discontinue compared to the unemployed (adjusted OR = 30.3, P = 0.015). Participants of parity equal to two were 89% less likely to discontinue use of FPBCs compared to those of parity equal to zero (adjusted OR = 0.1, P = 0.019). CONCLUSION Family planning benefits cards, deployed as incentives to increase uptake of family planning, exhibited high acceptability and utilization by youth in urban slums in Uganda. There was evidence that use of short-term contraception methods, professional employment, and lower parity were associated with discontinuation of modern family planning methods after initial enrolment. TRIAL REGISTRATION MUREC1/7 No. 10/05-17. Registered 19th, July 2017.
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Affiliation(s)
| | | | | | | | | | - Joseph B. Babigumira
- Department of Global Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-151-B, Box 357630, Seattle, WA 98195 USA
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Kuwawenaruwa A, Ramsey K, Binyaruka P, Baraka J, Manzi F, Borghi J. Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation. Soc Sci Med 2019; 225:17-25. [DOI: 10.1016/j.socscimed.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/24/2019] [Accepted: 02/03/2019] [Indexed: 11/25/2022]
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12
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Oyugi B, Kioko U, Kaboro SM, Okumu C, Ogola-Munene S, Kalsi S, Thiani S, Gikonyo S, Korir J, Baltazar B, Ranji M. A facility-based study of women' satisfaction and perceived quality of reproductive and maternal health services in the Kenya output-based approach voucher program. BMC Pregnancy Childbirth 2018; 18:310. [PMID: 30055576 PMCID: PMC6064123 DOI: 10.1186/s12884-018-1940-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is a facility-based study designed to assess perceived quality of care and satisfaction of reproductive health services under the output-based approach (OBA) services in Kenya from clients' perspective. METHOD An exit interview was conducted on 254 clients in public health facilities, non-governmental organizations, faith-based organizations and private facilities in Kitui, Kilifi, Kiambu, and Kisumu counties as well as in the Korogocho and Viwandani slums in Nairobi, Kenya using a 23-item scale questionnaire on quality of reproductive health services. Descriptive analysis, exploratory factor analysis, reliability test, and subgroup analysis using linear regression were performed. RESULTS Clients generally had a positive view on staff conduct and healthcare delivery but were neutral on hospital physical facilities, resources, and access to healthcare services. There was a high overall level of satisfaction among the clients with quick service, good handling of complications, and clean hospital stated as some of the reasons that enhanced satisfaction. The County of residence was shown to impact the perception of quality greatly with other social demographic characteristics showing low impact. CONCLUSION Majority of the women perceived the quality of OBA services to be high and were happy with the way healthcare providers were handling birth related complications. The conduct and practice of healthcare workers is an important determinant of client's perception of quality of reproductive and maternal health services. Findings can be used by health care managers as a guide to evaluate different areas of healthcare delivery and to improve resources and physical facilities that are crucial in elevating clients' level of satisfaction.
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Affiliation(s)
- Boniface Oyugi
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya. .,School of Public Health, Health Systems Management, University of Nairobi, P.O BOX 19676-00202, Nairobi, Kenya. .,Centre for Health Services Studies, University of Kent, Canterbury, CT2 7NX, UK.
| | - Urbanus Kioko
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | | | - Clarice Okumu
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | | | - Shaminder Kalsi
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | - Simon Thiani
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | - Shadrack Gikonyo
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | - Julius Korir
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | - Billy Baltazar
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | - Moses Ranji
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
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13
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Lam JA, Dang LT, Phan NT, Trinh HT, Vu NC, Nguyen CK. Mobile Health Initiatives in Vietnam: Scoping Study. JMIR Mhealth Uhealth 2018; 6:e106. [PMID: 29691214 PMCID: PMC5941098 DOI: 10.2196/mhealth.8639] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 02/15/2018] [Accepted: 03/10/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. OBJECTIVE The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. METHODS This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. RESULTS We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). CONCLUSIONS The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken.
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Affiliation(s)
| | - Linh Thuy Dang
- Institute of Population, Health and Development, Hanoi, Viet Nam
| | - Ngoc Tran Phan
- Institute of Population, Health and Development, Hanoi, Viet Nam
| | - Hue Thi Trinh
- Institute of Population, Health and Development, Hanoi, Viet Nam
| | - Nguyen Cong Vu
- Institute of Population, Health and Development, Hanoi, Viet Nam
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Weaver RG, Beets MW, Brazendale K, Brusseau TA. Summer Weight Gain and Fitness Loss: Causes and Potential Solutions. Am J Lifestyle Med 2018; 13:116-128. [PMID: 30800015 DOI: 10.1177/1559827617750576] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/20/2022] Open
Abstract
Over the past 3 decades, public health professionals have worked to stem the rising childhood obesity epidemic. Despite the field's best efforts, no progress has been made in reducing child obesity. One reason for this failure may be that obesity prevention and treatment efforts have predominately been delivered during the 9-month school year. However, recent evidence suggests that the summer, not the school year, is when unhealthy changes in body composition (ie, accelerated increases in percent body fat) and fitness losses occur. This unhealthy change in body composition and fitness loss during the summer could be explained by the "Structured Days Hypothesis," which posits that children engage in a greater number of unhealthy obesogenic behaviors on unstructured days when compared with structured days. Furthermore, the summer may be contributing to a widening "health gap" between children from low-income and middle- to upper-income families. During summer, fewer opportunities exist for children from low-income households to access healthy structured programs that do not require fees for participation. Moving forward, public health professionals should prioritize efforts to mitigate unhealthy changes in body composition and fitness loss during the summer by identifying ways to provide access to structured programming during this timeframe for children from low-income households.
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Affiliation(s)
- R Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
| | - Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
| | - Keith Brazendale
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
| | - Timothy A Brusseau
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (RGW, MWB, KB).,Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah (TAB)
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Nuwasiima A, Nuwamanya E, Navvuga P, Babigumira JU, Asiimwe FT, Lubinga SJ, Babigumira JB. Study protocol: incentives for increased access to comprehensive family planning for urban youth using a benefits card in Uganda. A quasi-experimental study. Reprod Health 2017; 14:140. [PMID: 29078815 PMCID: PMC5659021 DOI: 10.1186/s12978-017-0400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of contraception is one of the most cost-effective public health interventions and has the potential to prevent about 30% of maternal and 10% of child deaths in developing countries. Voucher-based initiatives for family planning are an effective and viable means of increasing contraceptive use. In this paper, we present a protocol for a pilot study of a novel incentive, a family planning benefits card (FPBC) program to increase uptake of family planning services among urban poor youth in Uganda while leveraging private sector funding. METHODS The study employs both impact and health economic evaluation methods to assess the effect of the FPBC program. We propose a quasi-experimental study design with two separate pre- and post-samples to measure program effectiveness. The main outcome of the impact evaluation is the percentage change in the prevalence of modern contraceptive use and unmet need for contraception. We will also conduct model-based incremental cost-effectiveness and budget impact analyses. The main outcomes of the economic evaluation are the cost per enrolled youth and cost per pregnancy averted, and cost per disability-adjusted life-year (DALY) averted. We will also pilot a corporate social responsibility model of sponsorship for the FPBC program in partnership with local corporations. Budget impact analysis will examine the potential affordability of scaling up the FPBC program and the fiscal implications of this scale up to the corporate social responsibility (CSR) budgets of partner corporations, the government, and the individual taxpayer. DISCUSSION In this study, we propose an impact and economic evaluation to establish the proof concept of using a FPBC program to increase uptake of family planning services among urban poor youth in Uganda. The results of this study will present stakeholders in Uganda and internationally with a potentially viable option for corporate-sponsored access to family planning in urban poor communities. TRIAL REGISTRATION MUREC1/7 No. 10/05-17. Registered 19th July 2017.
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Affiliation(s)
- Afra Nuwasiima
- Global Health Economics Ltd, P.O Box 27011, Kampala, Uganda.
| | - Elly Nuwamanya
- Global Health Economics Ltd, P.O Box 27011, Kampala, Uganda
| | | | | | | | - Solomon J Lubinga
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, P.O. Box 357630, Seattle, WA, 98195, USA.,Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Joseph B Babigumira
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, P.O. Box 357630, Seattle, WA, 98195, USA.,Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, 98195, USA
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Bellows B, Mackay A, Dingle A, Tuyiragize R, Nnyombi W, Dasgupta A. Increasing Contraceptive Access for Hard-to-Reach Populations With Vouchers and Social Franchising in Uganda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:446-455. [PMID: 28963175 PMCID: PMC5620340 DOI: 10.9745/ghsp-d-17-00065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022]
Abstract
Between 2011 and 2014, the program provided more than 330,000 family planning services, mostly to rural women in the informal sector with little or no education. 70% of the voucher clients chose an implant and 25% an intrauterine device. From 2001 to 2011, modern contraceptive prevalence in Uganda increased from 18% to 26%. However, modern method use, in particular use of long-acting reversible contraceptives (LARCs) and permanent methods (PMs), remained low. In the 2011 Uganda Demographic and Health Survey, only 1 of 5 married women used a LARC or PM even though 34% indicated an unmet need for contraception. Between 2011 and 2014, a social franchise and family planning voucher program, supporting 400 private facilities to provide family planning counseling and broaden contraceptive choice by adding LARCs and PMs to the service mix, offered a voucher to enable poor women to access family planning services at franchised facilities. This study analyzes service trends and voucher client demographics and estimates the contribution of the program to increasing contraceptive prevalence in Uganda, using the Impact 2 model developed by Marie Stopes International. Between March 2011 and December 2014, 330,826 women received a family planning service using the voucher, of which 70% of voucher clients chose an implant and 25% chose an intrauterine device. The median age of voucher users was 28 years; 79% had no education or only a primary education; and 48% reported they were unemployed or a housewife. We estimated that by 2014, 280,000 of the approximately 8,600,000 women of reproductive age in Uganda were using a contraceptive method provided by the program and that 120,000 of the clients were “additional users” of contraception, contributing 1.4 percentage points to the national modern contraceptive prevalence rate. The combination of family planning vouchers and a franchise-based quality improvement initiative can leverage existing private health infrastructure to substantially expand family planning access and choice for disadvantaged populations and potentially improve contraceptive prevalence when scaled nationally.
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Affiliation(s)
| | | | | | | | | | - Aisha Dasgupta
- Marie Stopes International, London, UK.,United Nations Population Division, New York, NY, USA
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Oyugi B, Kioko U, Kaboro SM, Gikonyo S, Okumu C, Ogola-Munene S, Kalsi S, Thiani S, Korir J, Odundo P, Baltazaar B, Ranji M, Muraguri N, Nzioka C. Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya. BMC Health Serv Res 2017; 17:236. [PMID: 28347306 PMCID: PMC5368892 DOI: 10.1186/s12913-017-2164-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/15/2017] [Indexed: 11/25/2022] Open
Abstract
Background The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility. Methods The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17. Results All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R2 value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning. Conclusion The study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.
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Affiliation(s)
- Boniface Oyugi
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya.
| | - Urbanus Kioko
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | | | - Shadrack Gikonyo
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | - Clarice Okumu
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | | | - Shaminder Kalsi
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | - Simon Thiani
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | - Julius Korir
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | - Paul Odundo
- University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya
| | - Billy Baltazaar
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
| | - Moses Ranji
- OBA Program Management Unit, Ministry of Health, Nairobi, Kenya
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Effectiveness of demand generation interventions on use of modern contraceptives in low‐ and middle‐income countries. Trop Med Int Health 2016; 21:1240-1254. [DOI: 10.1111/tmi.12758] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Oyewale TO, Ahmed S, Ahmed F, Tazreen M, Uddin Z, Rahman A, Oyediran KA. The use of vouchers in HIV prevention, referral treatment, and care for young MSM and young transgender people in Dhaka, Bangladesh: experience from 'HIM' initiative. Curr Opin HIV AIDS 2016; 11 Suppl 1:S37-45. [PMID: 26945145 PMCID: PMC4787106 DOI: 10.1097/coh.0000000000000268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The study described the effectiveness of a voucher scheme to access sexual and reproductive health and HIV services among young MSM and transgender people aged 15-24 years in Dhaka, Bangladesh, a country with HIV prevalence of less than 0.1%. METHODS Descriptive and analytical methods were used to assess the net effects of biodemographic factors of the respondents on the voucher scheme. Effectiveness of the scheme was contextualized as target population coverage, and turnaround time of voucher redemption to access services. RESULTS AND DISCUSSION A total of 210 (87.9%) out of the 239 vouchers distributed were redeemed. The mean age of the identified young people was 19.6 years (SD = +2.6 years). The coverage of the scheme against the target population of 200 young MSM and 936 young transgender people was 88% (n = 175) and 4% (n = 35) respectively, with P < 0.001. The median turnaround time for voucher redemption was 7 days. The predictors of voucher turnaround time were age, education, and population group (P < 0.001). HIV testing and counselling was accessed by 160 (76%) respondents, one was positive and linked to antiretroviral treatment and 110 (52%) were diagnosed and treated for sexually transmitted infections. CONCLUSION The voucher scheme was effective in linking young MSM with sexual and reproductive health and HIV services in Dhaka, Bangladesh. The findings are consistent with the low HIV prevalence in the country. The scheme is, however, not optimal for linking young transgender people with services.
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Affiliation(s)
| | | | - Farid Ahmed
- HIV Programme, UNICEF Bangladesh, Dhaka, Bangladesh
| | - Mona Tazreen
- HIV Programme, UNICEF Bangladesh, Dhaka, Bangladesh
| | - Ziya Uddin
- HIV Programme, United Nations Children's Fund
| | - Anisur Rahman
- National AIDS/STD Programme, Ministry of Health and Family Welfare, Dhaka, Bangladesh
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Burke A, Mbizvo M. Working to achieve "full access, full choice" for all. Int J Gynaecol Obstet 2015; 130 Suppl 3:E1-2. [PMID: 26190759 DOI: 10.1016/j.ijgo.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anne Burke
- Department of Gynecology and Obstetrics, Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, Johns Hopkins Bayview, 4940 Eastern Ave, A-101, Baltimore, MD 21224, USA.
| | - Mike Mbizvo
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
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