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

Obare F, Warren C, Njuki R, Abuya T, Sunday J, Askew I, Bellows B - Health Policy Plan (2012)

Bottom Line: The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all.Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all.However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Population Council, Ralph Bunche Road, P.O. Box 17643, Nairobi 00500, Kenya. fonyango@popcouncil.org

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

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Related in: MedlinePlus

Steps in sampling and data collection process
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czs033-F1: Steps in sampling and data collection process

Mentions: This paper uses data from the household survey that was conducted among women of reproductive age (15–49 years) living within a 5-km radius of contracted and similar non-contracted health facilities in three voucher sites (Kisumu, Kiambu and Kitui) and all the non-voucher sites. The primary sampling unit in the survey was the sub-location. In each district, 14 sub-locations were randomly selected from among those within the stipulated distance to contracted and non-contracted facilities (Figure 1). Three enumeration areas/villages were then randomly selected from each of the sampled sub-locations. Households considered poorest in the enumeration area/village were identified for inclusion in the study with the help of the local administration (Chiefs, Assistant Chiefs and village heads). This approach was informed by the need to capture as many individuals who would qualify for the vouchers as possible given that the vouchers are not randomly assigned to clients. The target sample size in each district in order to detect significant differences between respondents from voucher and comparison sites at 95% confidence level and 80% power was 400 women—about 10 women in each enumeration area/village.Figure 1


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

Obare F, Warren C, Njuki R, Abuya T, Sunday J, Askew I, Bellows B - Health Policy Plan (2012)

Steps in sampling and data collection process
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3584991&req=5

czs033-F1: Steps in sampling and data collection process
Mentions: This paper uses data from the household survey that was conducted among women of reproductive age (15–49 years) living within a 5-km radius of contracted and similar non-contracted health facilities in three voucher sites (Kisumu, Kiambu and Kitui) and all the non-voucher sites. The primary sampling unit in the survey was the sub-location. In each district, 14 sub-locations were randomly selected from among those within the stipulated distance to contracted and non-contracted facilities (Figure 1). Three enumeration areas/villages were then randomly selected from each of the sampled sub-locations. Households considered poorest in the enumeration area/village were identified for inclusion in the study with the help of the local administration (Chiefs, Assistant Chiefs and village heads). This approach was informed by the need to capture as many individuals who would qualify for the vouchers as possible given that the vouchers are not randomly assigned to clients. The target sample size in each district in order to detect significant differences between respondents from voucher and comparison sites at 95% confidence level and 80% power was 400 women—about 10 women in each enumeration area/village.Figure 1

Bottom Line: The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all.Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all.However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Population Council, Ralph Bunche Road, P.O. Box 17643, Nairobi 00500, Kenya. fonyango@popcouncil.org

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

Show MeSH
Related in: MedlinePlus