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Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya.

Obare F, Warren C, Kanya L, Abuya T, Bellows B - BMC Health Serv Res (2015)

Bottom Line: The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites.Although there were greater declines in the average amount paid for delivery and postnatal care services by women from voucher compared to those from non-voucher sites, the difference-in-differences estimates were not statistically significant.The reproductive health vouchers program in Kenya significantly contributed to reductions in the proportions of women in the community that paid out-of-pocket for safe motherhood services at health facilities.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Health Program, Population Council, Ralph Bunche Road, General Accident House, P.O. Box 17643, Nairobi, 00500, Kenya. fonyango@popcouncil.org.

ABSTRACT

Background: Although vouchers can protect individuals in low-income countries from financial catastrophe and impoverishment arising from out-of-pocket expenditures on healthcare, their effectiveness in achieving this goal depends on whether both service and transport costs are subsidized as well as other factors such as service availability in a given locality and community perceptions about the quality of care. This paper examines the community-level effect of the reproductive health vouchers program on out-of-pocket expenditure on family planning, antenatal, delivery and postnatal care services in Kenya.

Methods: Data are from two rounds of cross-sectional household surveys in voucher and non-voucher sites. The first survey was conducted between May 2010 and July 2011 among 2,933 women aged 15-49 years while the second survey took place between July and October 2012 among 3,094 women of similar age groups. The effect of the program on out-of-pocket expenditure is determined by difference-in-differences estimation. Analysis entails comparison of changes in proportions, means and medians as well as estimation of multivariate linear regression models with interaction terms between indicators for study site (voucher or non-voucher) and period of study (2010-2011 or 2012).

Results: There were significantly greater declines in the proportions of women from voucher sites that paid for antenatal, delivery and postnatal care services at health facilities compared to those from non-voucher sites. The changes were also consistent with increased uptake of the safe motherhood voucher in intervention sites over time. There was, however, no significant difference in changes in the proportions of women from voucher and non-voucher sites that paid for family planning services. The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites. Although there were greater declines in the average amount paid for delivery and postnatal care services by women from voucher compared to those from non-voucher sites, the difference-in-differences estimates were not statistically significant.

Conclusions: The reproductive health vouchers program in Kenya significantly contributed to reductions in the proportions of women in the community that paid out-of-pocket for safe motherhood services at health facilities.

No MeSH data available.


Related in: MedlinePlus

Healthcare expenditure in Kenya by source, 1996–2011. Source: Computed by the authors from the World Health Organization (2013) Global Health Expenditure Database
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Fig1: Healthcare expenditure in Kenya by source, 1996–2011. Source: Computed by the authors from the World Health Organization (2013) Global Health Expenditure Database

Mentions: In terms of contribution to the total healthcare expenditure, out-of-pocket spending consistently comprised the largest share of total healthcare expenditure in the country over the years. In particular, the percentage of total healthcare expenditure arising from out-of-pocket payments ranged from 42 % in 1996 to 48 % in 1999 while the share of government spending ranged from 39 % in 2008 and 2011 to 43 % in 2012 (Fig. 1). Healthcare spending from other private sources, on the other hand, ranged from 12 % in 1999 and 2002 to 18 % in 1996 (Fig. 1). Available evidence shows that households in Kenya spend about 10 % of their budget on healthcare with the burden being greater among poor than rich households and for outpatient compared to inpatient services [1]. Estimates further show that 5 % of households in Kenya face catastrophic expenditures on health according to WHO definition (expenditures comprising 40 % or higher of non-subsistence income) and that about 1.5 million people in the country are pushed into poverty due to healthcare payments [1].Fig. 1


Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya.

Obare F, Warren C, Kanya L, Abuya T, Bellows B - BMC Health Serv Res (2015)

Healthcare expenditure in Kenya by source, 1996–2011. Source: Computed by the authors from the World Health Organization (2013) Global Health Expenditure Database
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4548901&req=5

Fig1: Healthcare expenditure in Kenya by source, 1996–2011. Source: Computed by the authors from the World Health Organization (2013) Global Health Expenditure Database
Mentions: In terms of contribution to the total healthcare expenditure, out-of-pocket spending consistently comprised the largest share of total healthcare expenditure in the country over the years. In particular, the percentage of total healthcare expenditure arising from out-of-pocket payments ranged from 42 % in 1996 to 48 % in 1999 while the share of government spending ranged from 39 % in 2008 and 2011 to 43 % in 2012 (Fig. 1). Healthcare spending from other private sources, on the other hand, ranged from 12 % in 1999 and 2002 to 18 % in 1996 (Fig. 1). Available evidence shows that households in Kenya spend about 10 % of their budget on healthcare with the burden being greater among poor than rich households and for outpatient compared to inpatient services [1]. Estimates further show that 5 % of households in Kenya face catastrophic expenditures on health according to WHO definition (expenditures comprising 40 % or higher of non-subsistence income) and that about 1.5 million people in the country are pushed into poverty due to healthcare payments [1].Fig. 1

Bottom Line: The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites.Although there were greater declines in the average amount paid for delivery and postnatal care services by women from voucher compared to those from non-voucher sites, the difference-in-differences estimates were not statistically significant.The reproductive health vouchers program in Kenya significantly contributed to reductions in the proportions of women in the community that paid out-of-pocket for safe motherhood services at health facilities.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Health Program, Population Council, Ralph Bunche Road, General Accident House, P.O. Box 17643, Nairobi, 00500, Kenya. fonyango@popcouncil.org.

ABSTRACT

Background: Although vouchers can protect individuals in low-income countries from financial catastrophe and impoverishment arising from out-of-pocket expenditures on healthcare, their effectiveness in achieving this goal depends on whether both service and transport costs are subsidized as well as other factors such as service availability in a given locality and community perceptions about the quality of care. This paper examines the community-level effect of the reproductive health vouchers program on out-of-pocket expenditure on family planning, antenatal, delivery and postnatal care services in Kenya.

Methods: Data are from two rounds of cross-sectional household surveys in voucher and non-voucher sites. The first survey was conducted between May 2010 and July 2011 among 2,933 women aged 15-49 years while the second survey took place between July and October 2012 among 3,094 women of similar age groups. The effect of the program on out-of-pocket expenditure is determined by difference-in-differences estimation. Analysis entails comparison of changes in proportions, means and medians as well as estimation of multivariate linear regression models with interaction terms between indicators for study site (voucher or non-voucher) and period of study (2010-2011 or 2012).

Results: There were significantly greater declines in the proportions of women from voucher sites that paid for antenatal, delivery and postnatal care services at health facilities compared to those from non-voucher sites. The changes were also consistent with increased uptake of the safe motherhood voucher in intervention sites over time. There was, however, no significant difference in changes in the proportions of women from voucher and non-voucher sites that paid for family planning services. The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites. Although there were greater declines in the average amount paid for delivery and postnatal care services by women from voucher compared to those from non-voucher sites, the difference-in-differences estimates were not statistically significant.

Conclusions: The reproductive health vouchers program in Kenya significantly contributed to reductions in the proportions of women in the community that paid out-of-pocket for safe motherhood services at health facilities.

No MeSH data available.


Related in: MedlinePlus