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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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Shamanna BR, Murthy G, Ravilla T, Jones I. Demand-side financing: can it help deliver eye care for all? COMMUNITY EYE HEALTH 2022; 35:27-28. [PMID: 36425859 PMCID: PMC9680598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- B R Shamanna
- School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Gvs Murthy
- Director - Indian Institute of Public Health, Hyderabad, India
| | - Thulsiraj Ravilla
- Executive Director: Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
| | - Iain Jones
- Senior Global Technical Lead Economics Research: Sightsavers, UK
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Bhatia D, Mishra S, Kirubarajan A, Yanful B, Allin S, Di Ruggiero E. Identifying priorities for research on financial risk protection to achieve universal health coverage: a scoping overview of reviews. BMJ Open 2022; 12:e052041. [PMID: 35264342 PMCID: PMC8915291 DOI: 10.1136/bmjopen-2021-052041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Financial risk protection (FRP) is an indicator of the Sustainable Development Goal 3 universal health coverage (UHC) target. We sought to characterise what is known about FRP in the UHC context and to identify evidence gaps to prioritise in future research. DESIGN Scoping overview of reviews using the Arksey & O'Malley and Levac & Colquhoun framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. DATA SOURCES MEDLINE, PsycINFO, CINAHL-Plus and PAIS Index were systematically searched for studies published between 1 January 1995 and 20 July 2021. ELIGIBILITY CRITERIA Records were screened by two independent reviewers in duplicate using the following criteria: (1) literature review; (2) focus on UHC achievement through FRP; (3) English or French language; (4) published after 1995 and (5) peer-reviewed. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data using a standard form and descriptive content analysis was performed to synthesise findings. RESULTS 50 studies were included. Most studies were systematic reviews focusing on low-income and middle-income countries. Study periods spanned 1990 and 2020. While FRP was recognised as a dimension of UHC, it was rarely defined as a concept. Out-of-pocket, catastrophic and impoverishing health expenditures were most commonly used to measure FRP. Pooling arrangements, expansion of insurance coverage and financial incentives were the main interventions for achieving FRP. Evidence gaps pertained to the effectiveness, cost-effectiveness and equity implications of efforts aimed at increasing FRP. Methodological gaps related to trade-offs between single-country and multicountry analyses; lack of process evaluations; inadequate mixed-methods evidence, disaggregated by relevant characteristics; lack of comparable and standardised measurement and short follow-up periods. CONCLUSIONS This scoping overview of reviews characterised what is known about FRP as a UHC dimension and found evidence gaps related to the effectiveness, cost-effectiveness and equity implications of FRP interventions. Theory-informed mixed-methods research using high-quality, longitudinal and disaggregated data is needed to address these objectives.
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Affiliation(s)
- Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abirami Kirubarajan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Bernice Yanful
- Public Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Public Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Lee S, Adam AJ. Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:295. [PMID: 35010561 PMCID: PMC8744962 DOI: 10.3390/ijerph19010295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Despite the increasing transition from paper vouchers to mobile e-vouchers for maternal health in low- and middle-income countries, few studies have reviewed key elements for program planning, implementation, and evaluation. To bridge this gap, this study conducted an interpretive review and developed a logic model for mobile maternal health e-voucher programs. Pubmed, EMBASE, and Cochrane databases were searched to retrieve relevant studies; 27 maternal health voucher programs from 84 studies were identified, and key elements for the logic model were retrieved and organized systematically. Some of the elements identified have the potential to be improved greatly by shifting to mobile e-vouchers, such as payment via mobile money or electronic claims processing and data entry for registration. The advantages of transitioning to mobile e-voucher identified from the logic model can be summarized as scalability, transparency, and flexibility. The present study contributes to the literature by providing insights into program planning, implementation, and evaluation for mobile maternal health e-voucher programs.
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Affiliation(s)
- Seohyun Lee
- Department of Global Public Administration, Mirae Campus, Yonsei University, Wonju 26493, Korea
| | - Abdul-jabiru Adam
- Department of Public Administration, Mirae Campus, Yonsei University Graduate School, Wonju 26493, Korea;
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Huang J, Ngai CH, Tin MS, Sun Q, Tin P, Yeoh EK, Wong MCS. Healthcare Voucher Scheme for Screening of Cardiovascular Risk Factors: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010844. [PMID: 34682589 PMCID: PMC8535674 DOI: 10.3390/ijerph182010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
The present study aimed to evaluate the factors associated with unwillingness to join a healthcare voucher scheme for screening of cardiovascular risk factors in a Chinese population. We conducted a telephone survey by random selection of 1200 subjects who were aged 45 years or above in Hong Kong. We collected data on their attitude, perception, and perceived feasibility of a healthcare voucher scheme. The overall rates of having received at least one type, two types, and all three types of screening tests are 81.1%, 80.7%, and 79.3%, respectively. Younger individuals (aOR = 0.338, p = 0.004), those of a higher educational level (aOR = 1.825, p = 0.006), being employed (aOR = 3.030, p = 0.037), and lower perception of screening as beneficial (aOR = 0.495, p < 0.001) were significantly associated with no regular screening for at least one medical condition. The overall rate of willingness to join the voucher scheme (among those aged ≥ 45) is 83.7%. Male sex (aOR = 2.049, p = 0.010) and absence of family history of cardiovascular disease (aOR = 0.362, p = 0.002) are independent predictors of unwillingness to join. Our findings highlighted the significance of sex and family history on screening of cardiovascular factors. These constructs and independent predictors identified provide evidence-based formulation and implementation targeted screening strategies that enhance the screening rate of the three cardiovascular risk factors.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR 999077, China; (J.H.); (C.-H.N.); (M.-S.T.); (Q.S.)
| | - Chun-Ho Ngai
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR 999077, China; (J.H.); (C.-H.N.); (M.-S.T.); (Q.S.)
| | - Man-Sing Tin
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR 999077, China; (J.H.); (C.-H.N.); (M.-S.T.); (Q.S.)
| | - Qingjie Sun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR 999077, China; (J.H.); (C.-H.N.); (M.-S.T.); (Q.S.)
| | - Pamela Tin
- Department of Healthcare and Social Development Research, Our Hong Kong Foundation, Hong Kong SAR 999077, China;
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR 999077, China; (J.H.); (C.-H.N.); (M.-S.T.); (Q.S.)
- Correspondence: (E.-K.Y.); (M.C.S.W.)
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR 999077, China; (J.H.); (C.-H.N.); (M.-S.T.); (Q.S.)
- School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
- Department of Global Health, School of Public Health, Peking University, Beijing 100871, China
- Correspondence: (E.-K.Y.); (M.C.S.W.)
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Chong KC, Fung H, Yam CHK, Chau PYK, Chow TY, Zee BCY, Wong ELY, Wang MH, Yeoh EK. Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis. BMC Public Health 2021; 21:1235. [PMID: 34174858 PMCID: PMC8236172 DOI: 10.1186/s12889-021-11280-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11280-z.
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Affiliation(s)
- Ka Chun Chong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China. .,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.
| | - Hong Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Carrie Ho Kwan Yam
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Patsy Yuen Kwan Chau
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Tsz Yu Chow
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Benny Chung Ying Zee
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Eliza Lai Yi Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Maggie Haitian Wang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Eng Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China.,Centre for Health System and Policy Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
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Ravindran TKS, Govender V. Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries. Sex Reprod Health Matters 2020; 28:1779632. [PMID: 32530387 PMCID: PMC7887992 DOI: 10.1080/26410397.2020.1779632] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what then is the current situation vis-à-vis universal coverage of SRH services, and the extent to which SRH services have been prioritised in national UHC plans and processes? This was the central question that guided this critical review of more than 200 publications between 2010 and 2019. The findings are the following. The Essential Package of Healthcare Services (EPHS) across many countries excludes several critical SRH services (e.g. safe abortion services, reproductive cancers) that are already poorly available. Inadequate international and domestic public funding of SRH services contributes to a sustained burden of out-of-pocket expenditure (OOPE) and inequities in access to SRH services. Policy and legal barriers, restrictive gender norms and gender-based inequalities challenge the delivery and access to quality SRH services. The evidence is mixed as to whether an expanded role and scope of the private sector improves availability and access to services of underserved populations. As momentum gathers towards SRH and UHC, the following actions are necessary and urgent. Advocacy for greater priority for SRH in government EPHS and health budgets aligned with SRH and UHC goals is needed. Implementation of stable and sustained financing mechanisms that would reduce the proportion of SRH-financing from OOPE is a priority. Evidence, moving from descriptive towards explanatory studies which provide insights into the "hows" and "whys" of processes and pathways are essential for guiding policy and programme actions.
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Affiliation(s)
- T. K. Sundari Ravindran
- Principal Visiting Fellow, United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Veloshnee Govender
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Hirai M, Morris J, Luoto J, Ouda R, Atieno N, Quick R. The impact of supply-side and demand-side interventions on use of antenatal and maternal services in western Kenya: a qualitative study. BMC Pregnancy Childbirth 2020; 20:453. [PMID: 32770963 PMCID: PMC7414717 DOI: 10.1186/s12884-020-03130-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 07/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background Antenatal care (ANC) and delivery by skilled providers have been well recognized as effective strategies to prevent maternal and neonatal mortality. ANC and delivery services at health facilities, however, have been underutilized in Kenya. One potential strategy to increase the demand for ANC services is to provide health interventions as incentives for pregnant women. In 2013, an integrated ANC program was implemented in western Kenya to promote ANC visits by addressing both supply- and demand-side factors. Supply-side interventions included nurse training and supplies for obstetric emergencies and neonatal resuscitation. Demand-side interventions included SMS text messages with appointment reminders and educational contents, group education sessions, and vouchers to purchase health products. Methods To explore pregnant mothers’ experiences with the intervention, ANC visits, and delivery, we conducted focus group discussions (FGDs) at pre- and post-intervention. A total of 19 FGDs were held with pregnant mothers, nurses, and community health workers (CHWs) during the two assessment periods. We performed thematic analyses to highlight study participants’ perceptions and experiences. Results FGD data revealed that pregnant women perceived the risks of home-based delivery, recognized the benefits of facility-based delivery, and were motivated by the incentives to seek care despite barriers to care that included poverty, lack of transport, and poor treatment by nurses. Nurses also perceived the value of incentives to attract women to care but described obstacles to providing health care such as overwork, low pay, inadequate supplies and equipment, and insufficient staff. CHWs identified the utility and limitations of text messages for health education. Conclusions Future interventions should ensure that adequate workforce, training, and supplies are in place to respond to increased demand for maternal and child health services stimulated by incentive programs.
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Affiliation(s)
- Mitsuaki Hirai
- Division of Global Health Protection, Office of the Director, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Jamae Morris
- Department of African American Studies, Georgia State University, 33 Gilmer Street SE, Atlanta, GA, 30303, USA
| | - Jill Luoto
- RAND Corporation, Santa Monica, CA, 90407, USA
| | - Rosebel Ouda
- Safe Water and AIDS Project, P.O Box 3323, Kisumu, 40100, Kenya
| | - Nancy Atieno
- Safe Water and AIDS Project, P.O Box 3323, Kisumu, 40100, Kenya
| | - Robert Quick
- National Center for Emerging and Zoonotic Infectious Diseases, Office of Infectious Diseases Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
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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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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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Keya KT, Bellows B, Rob U, Warren C. Improving Access to Delivery Care and Reducing the Equity Gap Through Voucher Program in Bangladesh: Evidence From Difference-in-Differences Analysis. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2018; 38:137-145. [PMID: 29298635 DOI: 10.1177/0272684x17749568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To test a statistically significant change in delivery by medically trained providers following introduction of a demand-side financing voucher, a population-based quasi-experimental study was undertaken, with 3,300 mothers in 2010 and 3,334 mothers at follow-up in 2012 in government-implemented voucher program and control areas. Results found that voucher program was significantly associated with increased public health facility use (difference-in-differences (DID) 13.9) and significantly increased delivery complication management care (DID 13.2) at facility although a null effect was found in facility-based delivery increase. A subset analysis of the five well-functioning facilities showed that facility deliveries increased DID 5.3 percentage points. Quintile-based analysis of all facilities showed that facility delivery increased more than threefold in lower quintile households comparing to twofold in control sites. The program needs better targeting to the beneficiaries, ensuring available gynecologist-anesthetist pair and midwives, effective monitoring, and timely fund reimbursements to facilities.
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Iyer V, Sidney K, Mehta R, Mavalankar D, De Costa A. Characteristics of private partners in Chiranjeevi Yojana, a public-private-partnership to promote institutional births in Gujarat, India - Lessons for universal health coverage. PLoS One 2017; 12:e0185739. [PMID: 29040336 PMCID: PMC5644975 DOI: 10.1371/journal.pone.0185739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/15/2017] [Indexed: 02/05/2023] Open
Abstract
Background The Chiranjeevi Yojana (CY) is a Public-Private-Partnership between the state and private obstetricians in Gujarat, India, since 2007. The state pays for institutional births of the most vulnerable households (below-poverty-line and tribal) in private hospitals. An innovative remuneration package has been designed to disincentivise unnecessary cesareans. This study examines characteristics of private facilities which participated in the program. Methods We conducted a cross-sectional survey of all facilities which had conducted any births between June 2012 and April 2013 in three districts. We identified 111 private and 47 public facilities. Ninety of the 111 private facilities did caesarean sections in the last three months and were eligible to participate in the CY program. Of these, 40 (44%) participated in the CY program. We conducted descriptive and bivariate analyses followed by a Poisson regression model to estimate prevalence ratios of facility characteristics that predicted participation. Results We found that facilities participating in the CY program had a significantly higher likelihood of being general facilities (PR 1.9, 95% CI 1.3–2.9), or conducting lower proportion of cesarean births (PR 2.1, 95% CI 1.2–3.5) or having obstetricians new in private practice (PR 1.9, 95% CI 1.2–3.1) or being less expensive (PR 1.8, 95% CI 1.1–3.0). But none of these factors retained significance in a multi variable model. Conclusion Private obstetricians who participate in the CY program tend to be new to private practice, provide general services, conduct fewer caesareans and are also less expensive. This is advantageous to the PPP and widens the target beneficiary groups that can be serviced by the PPP. The state should design remuneration packages with the aim of attracting relatively new obstetricians to set up practices in more remote areas. It is possible that the CY remuneration package design is effective in keeping caesarean rates in check, and needs to be studied further.
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Affiliation(s)
- Veena Iyer
- Indian Institute of Public Health, Gandhinagar, Gujarat, India.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kristi Sidney
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Rajesh Mehta
- Department of Preventive and Social Medicine, Valsad Medical College, Valsad, Gujarat, India
| | | | - Ayesha De Costa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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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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Burke E, Gold J, Razafinirinasoa L, Mackay A. Youth Voucher Program in Madagascar Increases Access to Voluntary Family Planning and STI Services for Young People. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:33-43. [PMID: 28232368 PMCID: PMC5493449 DOI: 10.9745/ghsp-d-16-00321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Young people often express a preference for seeking family planning information and services from the private sector. However, in many Marie Stopes International (MSI) social franchise networks, the proportion of young clients, and particularly those under 20 years of age, remains low. Marie Stopes Madagascar (MSM) piloted a youth voucher program that joins a supply-side intervention-youth-friendly social franchisee training and quality monitoring-with a corresponding demand-side-component, free vouchers that reduce financial barriers to family planning access for young people. METHODS Young people identified by MSM's community health educators (CHEs) received a free voucher redeemable at a BlueStar social franchisee for a package of voluntary family planning and sexually transmitted infection (STI) information and services. BlueStar social franchisees-private providers accredited by MSM-are reimbursed for the cost of providing these services. We reviewed service statistics data from the first 18 months of the youth voucher program, from July 2013 to December 2014, as well as client demographic profile data from July 2015.Findings: Between July 2013 and December 2014, 58,417 vouchers were distributed to young people by CHEs through a range of community mobilization efforts, of which 43,352 (74%) were redeemed for family planning and STI services. Most clients (78.5%) chose a long-acting reversible contraceptive (LARC), and just over half (51%) of young people benefited from STI counseling as part of their voucher service. Most (78%) services were provided in the Analamanga region (the capital and its surroundings), which was expected given the population density in this region and the high concentration of BlueStar franchisees. The client profile data snapshot from July 2015 revealed that 69% of voucher clients had never previously used a contraceptive method, and 96% of clients were aged 20 or younger, suggesting that the voucher program is successfully reaching the intended target group. CONCLUSION MSM's youth voucher program has revealed a high demand for voluntary family planning services, especially among youth under 20 years old, and MSM has since integrated the youth voucher beyond the initial pilot locations. MSM's experience indicates that youth vouchers are a novel and effective means of increasing young people's access to voluntary family planning services in Madagascar, and this model could potentially be replicated or adapted in other contexts where young people are faced with barriers to accessing quality information and services.
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Affiliation(s)
- Eva Burke
- Independent consultant, London, England.
| | - Judy Gold
- Independent consultant, Melbourne, Australia
| | | | - Anna Mackay
- Marie Stopes International, New York, United States
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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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Thongkong N, van de Poel E, Roy SS, Rath S, Houweling TAJ. How equitable is the uptake of conditional cash transfers for maternity care in India? Evidence from the Janani Suraksha Yojana scheme in Odisha and Jharkhand. Int J Equity Health 2017; 16:48. [PMID: 28283045 PMCID: PMC5345245 DOI: 10.1186/s12939-017-0539-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 02/21/2017] [Indexed: 11/25/2022] Open
Abstract
Background In 2005, the Indian Government introduced the Janani Suraksha Yojana (JSY) scheme - a conditional cash transfer program that incentivizes women to deliver in a health facility – in order to reduce maternal and neonatal mortality. Our study aimed to measure and explain socioeconomic inequality in the receipt of JSY benefits. Methods We used prospectively collected data on 3,682 births (in 2009–2010) from a demographic surveillance system in five districts in Jharkhand and Odisha state, India. Linear probability models were used to identify the determinants of receipt of JSY benefits. Poor-rich inequality in the receipt of JSY benefits was measured by a corrected concentration index (CI), and the most important drivers of this inequality were identified using decomposition techniques. Results While the majority of women had heard of the scheme (94% in Odisha, 85% in Jharkhand), receipt of JSY benefits was comparatively low (62% in Odisha, 20% in Jharkhand). Receipt of the benefits was highly variable by district, especially in Jharkhand, where 5% of women in Godda district received the benefits, compared with 40% of women in Ranchi district. There were substantial pro-rich inequalities in JSY receipt (CI 0.10, standard deviation (SD) 0.03 in Odisha; CI 0.18, SD 0.02 in Jharkhand) and in the institutional delivery rate (CI 0.16, SD 0.03 in Odisha; CI 0.30, SD 0.02 in Jharkhand). Delivery in a public facility was an important determinant of receipt of JSY benefits and explained a substantial part of the observed poor-rich inequalities in receipt of the benefits. Yet, even among public facility births in Jharkhand, pro-rich inequality in JSY receipt was substantial (CI 0.14, SD 0.05). This was largely explained by district-level differences in wealth and JSY receipt. Conversely, in Odisha, poorer women delivering in a government institution were at least as likely to receive JSY benefits as richer women (CI −0.05, SD 0.03). Conclusion JSY benefits were not equally distributed, favouring wealthier groups. These inequalities in turn reflected pro-rich inequalities in the institutional delivery. The JSY scheme is currently not sufficient to close the poor-rich gap in institutional delivery rate. Important barriers to institutional delivery remain to be addressed and more support is needed for low performing districts and states.
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Affiliation(s)
- Nattawut Thongkong
- Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Ellen van de Poel
- Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Swati Sarbani Roy
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, PIN: 833102, India
| | - Shibanand Rath
- Ekjut, Plot 556B, Potka, Chakradharpur, West Singhbhum, Jharkhand, PIN: 833102, India
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Menotti EP, Farrell M. Vouchers: A Hot Ticket for Reaching the Poor and Other Special Groups With Voluntary Family Planning Services. GLOBAL HEALTH: SCIENCE AND PRACTICE 2016; 4:384-93. [PMID: 27669707 PMCID: PMC5042695 DOI: 10.9745/ghsp-d-16-00084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022]
Abstract
Vouchers can be a highly effective tool to increase access to and use of family planning and reproductive health services, especially for special populations including the poor, youth, and postpartum women. Voucher programs need to include social and behavior change communication with clients and quality assurance for providers, whether in the private or public sector. In the longer term, voucher programs can strengthen health systems capacity and provide a pathway to strategic purchasing such as insurance or contracting.
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Affiliation(s)
- Elaine P Menotti
- United States Agency for International Development, Washington, DC, USA
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18
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Govil D, Purohit N, Gupta SD, Mohanty SK. Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2016; 35:15. [PMID: 27207164 PMCID: PMC5025966 DOI: 10.1186/s41043-016-0051-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/03/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period. METHODS Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE. RESULTS The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE. CONCLUSIONS Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened.
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Affiliation(s)
- Dipti Govil
- Department of Population Policies and Programs, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India.
| | - Neetu Purohit
- The IIHMR University, 1, Prabhu Dayal Marg, Near Sanganer Airport, Jaipur, 302029, Rajasthan, India
| | - Shiv Dutt Gupta
- The IIHMR University, 1, Prabhu Dayal Marg, Near Sanganer Airport, Jaipur, 302029, Rajasthan, India
| | - Sanjay Kumar Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
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Azmat SK, Hameed W, Hamza HB, Mustafa G, Ishaque M, Abbas G, Khan OF, Asghar J, Munroe E, Ali S, Hussain W, Ali S, Ahmed A, Ali M, Temmerman M. Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions. Reprod Health 2016; 13:25. [PMID: 26987368 PMCID: PMC4797360 DOI: 10.1186/s12978-016-0145-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 03/01/2016] [Indexed: 12/03/2022] Open
Abstract
Background Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society - Pakistan implemented an operational research project - ‘Evidence for Innovating to Save Lives’, to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan. Methods We conducted a quasi-experimental (pre - and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, 1) Suraj model (meaning ‘Sun’ in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and 2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls. Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata® version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model. Results The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14 % percentage points, current contraceptive use by 5 % percentage points and long term modern method - intrauterine device (IUD) use by 6 % percentage points. The CMW model significantly increased contraceptive awareness by 28 % percentage points, ever use of contraceptives by 7 % percentage points and, IUD use by 3 % percentage points. Additionally the Suraj intervention led to a 35 % greater prevalence (prevalence ratio: 1.35, 95 % CI: 1.22–1.50) of contraceptive use among MWRA. Conclusion Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.
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Affiliation(s)
- Syed Khurram Azmat
- Department of Urogynecology, University of Ghent, Ghent, Belgium. .,The Hospital for Sick Children, Toronto, Ontario, Canada. .,Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan.
| | - Waqas Hameed
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Hasan Bin Hamza
- Freelance Public Health Professional, Adelaide, South Australia, Australia
| | - Ghulam Mustafa
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Muhammad Ishaque
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Ghazunfer Abbas
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Omar Farooq Khan
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Jamshaid Asghar
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Erik Munroe
- Research, Monitoring and Evaluation Department, Marie Stopes International, London, UK
| | - Safdar Ali
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Wajahat Hussain
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Sajid Ali
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Aftab Ahmed
- Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Grainger C, Gorter A, Okal J, Bellows B. Erratum: Lessons from sexual and reproductive health voucher program design and function: a comprehensive review. Int J Equity Health 2015; 14:20. [PMID: 25881317 PMCID: PMC4329648 DOI: 10.1186/s12939-015-0139-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Corinne Grainger
- Options Consultancy Services Ltd., Senior Technical Specialist, Devon House, 58 St Katharine's Way, London, E1W 1LB, UK.
| | - Anna Gorter
- Instituto CentroAmericano de la Salud, Epidemiology, Managua, Nicaragua.
| | - Jerry Okal
- Population Council, Ralph Bunche Rd, PO Box 17643-00500, Nairobi, Kenya.
| | - Ben Bellows
- Population Council, Ralph Bunche Rd, PO Box 17643-00500, Nairobi, Kenya.
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Amendah DD, Mutua MK, Kyobutungi C, Buliva E, Bellows B. Reproductive health voucher program and facility based delivery in informal settlements in Nairobi: a longitudinal analysis. PLoS One 2013; 8:e80582. [PMID: 24260426 PMCID: PMC3832453 DOI: 10.1371/journal.pone.0080582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/04/2013] [Indexed: 11/28/2022] Open
Abstract
Introduction In Kenya, the maternal mortality rate had ranged from 328 to 501 deaths per 100,000 live births over the last three decades. To reduce these rates, the government launched in 2006 a means-tested reproductive health output-based approach (OBA) voucher program that covers costs of antenatal care, a facility-based delivery (FBD) and a postnatal visit in prequalified healthcare facilities. This paper investigated whether women who bought the voucher for their index child and had a FBD were more likely to deliver a subsequent child in a facility compared to those who did not buy vouchers. Methods and Findings We used population-based cohort data from two Nairobi slums where the voucher program was piloted. We selected mothers of at least two children born between 2006 and 2012 and divided the mothers into two groups: Index-OBA mothers bought the voucher for the index child (N=352), and non-OBA mothers did not buy the voucher during the study period (N=514). The most complete model indicated that the adjusted odds-ratio of FBD of subsequent child when the index child was born in a facility was 3.89 (p<0.05) and 4.73 (p<0.01) in Group 2. Discussion and Conclusion The study indicated that the voucher program improved poor women access to FBD. Furthermore, the FBD of an index child appeared to have a persistent effect, as a subsequent child of the same mother was more likely to be born in a facility as well. While women who purchased the voucher have higher odds of delivering their subsequent child in a facility, those odds were smaller than those of the women who did not buy the voucher. However, women who did not buy the voucher were less likely to deliver in a good healthcare facility, negating their possible benefit of facility-based deliveries. Pathways to improve access to FBD to all near poor women are needed.
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Affiliation(s)
| | | | | | - Evans Buliva
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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