Online Program

Population-level impact of vouchers on access to health facility delivery for women in Kenya

Tuesday, November 5, 2013 : 11:00 a.m. - 11:15 a.m.

Francis Obare, Population Council, Nairobi, Kenya
Charlotte Warren, Reproductive Health, Population Council, Washington, DC, DC
Timothy Abuya, Reproductive Health, Population Council, Nairobi, Kenya
Claire Watt, Harvard School of Public Health, Boston, MA
Ian Askew, Population Council, Nairobi, Kenya
Ben Bellows, Reproductive Health, Population Council, Nairobi, Kenya
Background: Available evidence indicates that vouchers improve service utilization among the target populations. A key question is whether increased utilization results from improved access or from shifting clients from non-accredited to contracted service providers. This paper examines whether the safe motherhood voucher program in Kenya is associated with improved access to health facility delivery over time using information on births within two years preceding the survey in voucher and comparison sites. Methods: Data were collected in 2010-2011 and in 2012 among 2,933 and 3,094 women aged 15-49 years reporting 962 and 1,494 births within two years before the respective surveys. Analysis entails cross-tabulations and estimation of multilevel random-intercept logit models. Results: The proportion of births occurring at home declined by more than 10 percentage points while the proportion of births delivered in health facilities increased by a similar margin over time in voucher sites. The increase in facility-based births was consistent across public and private health facilities. There was also significant increase in the likelihood of facility-based delivery (odds ratios [OR]: 2.04; 95% confidence interval [CI]: 1.40 – 2.98 in the 2006 voucher arm; OR: 1.72; 95% CI: 1.22 – 2.43 in the 2010-2011 voucher arm) which was accompanied by significant decline in home-based births in voucher sites over time. In contrast, there were no significant changes in the likelihood of facility or home-based delivery in the comparison sites over time. Conclusion: The voucher program contributed to improved access to institutional delivery by shifting births from home to health facilities.

Learning Areas:

Public health or related public policy

Learning Objectives:
Assess whether maternal health vouchers improve access to health facility delivery in a low-income country

Keyword(s): Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a graduate student at the Harvard School of Public Health, my previous work includes implementation of maternal and child community health programs in Tanzania and Rwanda, as well as research on the impacts of armed conflict on child mortality with Stanford University’s Center for Health Policy. My current research with Population Council focuses on the impact of the Kenya’s voucher program on quality of postnatal care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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