Resources

Title: Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh

Authors: Ubaidur Rob, Md. Moshiur Rahman, Benjamin Bellows

Journal: BMC Public Health 11(1): 257-257

Publication date: 2011

Abstract:

Background: Cost of delivering reproductive health services to low-income populations will always require total or partial subsidization by the government and/or development partners. Broadly termed “Demand-Side Financing” or “Output-Based Aid”, includes a range of interventions that channel government or donor subsidies to the service user rather than the service provider. Initial findings from the few assessments of reproductive health voucher-and-accreditation programs suggest that, if implemented well, these programs have great potential for achieving the policy objectives of increasing access and use, reducing inequities and enhancing program efficiency and service quality. At this point in time, however, there is a paucity of evidence describing how the various voucher programs function in different settings, for various reproductive health services.

Methods: Population Council-Nairobi, funded by the Bill and Melinda Gates Foundation, intends to address the lack of evidence around the pros and cons of ‘voucher and accreditation’ approaches to improving the reproductive health of low income women in five developing countries. In Bangladesh, the activities will be conducted in 11 accredited health facilities where Demand Side Financing program is being implemented and compared with populations drawn from areas served by similar non-accredited facilities. Facility inventories, client exit interviews and service provider interviews will be used to collect comparable data across each facility for assessing readiness and quality of care. In-depth interviews with key stakeholders will be conducted to gain a deeper understanding about the program. A population-based survey will also be carried out in two types of locations: areas where vouchers are distributed and similar locations where vouchers are not distributed.

Discussion: This is a quasi-experimental study which will investigate the impact of the voucher approach on improving maternal health behaviors and status and reducing inequities at the population level. We expect a significant increase in the utilization of maternal health care services by the accredited health facilities in the experimental areas compared to the control areas as a direct result of the interventions. If the voucher scheme in Bangladesh is found effective, it may help other countries to adopt this approach for improving utilization of maternity care services for reducing maternal mortality.

Offsite link: http://www.biomedcentral.com/content/pdf/1471-2458-11-257.pdf

Abstract:

Title: Using vouchers to increase access to maternal healthcare in Bangladesh

Authors: Ubaidur Rob, Md. Moshiur Rahman, Benjamin Bellows

Journal: International Quarterly of Community Health Education 30(4): 293-309

Abstract: The maternal mortality ratio (322) is comparatively high in Bangladesh. The utilization of maternity care provided by trained professionals during and after delivery is alarmingly low, primarily due to lack of knowledge and money. The overall objective of this operations research project was to test the feasibility and effectiveness of introducing financial support (voucher scheme) for poor rural women to improve utilization of antenatal care (ANC), delivery and postnatal check-up (PNC) from trained service providers. A pretest-posttest design was utilized. A total of 436 women were interviewed before and 414 after the intervention to evaluate the impact of interventions. In-depth interviews were conducted with users and non-users of vouchers. Findings show that institutional deliveries have increased from 2% to 18%. Utilization of ANC from trained providers has increased from 42% to 89%. Similarly, utilization of PNC from trained providers has increased from 10% to 60%.

Offsite link: http://baywood.metapress.com/link.asp?id=n4437w2h677451g7

The information in this report is drawn from a 2011 review and assessment of the information management systems of five reproductive health voucher programs in Bangladesh, Cambodia, Kenya, Uganda, and Tanzania. The report defines the key elements needed to support the development of effective, scalable voucher information systems. While it focuses on reproductive health voucher programs specifically, the information from the report will have relevance to information systems issues for other types of voucher programs as well.

This report is intended for two audiences: (1) those involved in resource allocation related to current or new voucher programs; and (2) those operationally involved in the design, development, or improvement of voucher programs. It assumes a basic working knowledge of the function and purpose of voucher programs.

Authors: Francis Obare, Charlotte Warren, Rebecca Njuki, Timothy Abuya, Joseph Sunday, Ian Askew, Benjamin Bellows

Journal:  Health Policy and Planning 28(2): 165-175

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.