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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya
Health Policy and Planning, Volume 28, No. 2, Year 2013
Notification
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Description
Objective To measure whether there was an association between the introduction of an output-based voucher programme and the odds of a facility-based delivery in two Nairobi informal settlements.Data sources Nairobi Urban Health and Demographic Surveillance System (NUHDSS) and two cross-sectional household surveys in Korogocho and Viwandani informal settlements in 2004-05 and 2006-08.Methods Odds of facility-based delivery were estimated before and after introduction of an output-based voucher. Supporting NUHDSS data were used to determine whether any trend in maternal health care was coincident with immunizations, a non-voucher outpatient service. As part of NUHDSS, households in Korogocho and Viwandani reported place of delivery and the presence of a skilled birth attendant (2003-10) and vaccination coverage (2003-09). A detailed maternal and child health (MCH) tool was added to NUHDSS (September 2006-10). Prospective enrolment in NUHDSS-MCH was conditional on having a newborn after September 2006. In addition to recording mother's place of delivery, NUHDSS-MCH recorded the use of the voucher.Findings There were significantly greater odds of a facility-based delivery among respondents during the voucher programme compared with similar respondents prior to voucher launch. Testing whether unrelated outpatient care also increased, a falsification exercise found no significant increase in immunizations for children 12-23 months of age in the same period. Although the proportion completing any antenatal care (ANC) visit remained above 95% of all reported pregnancies and there was a significant increase in facility-based deliveries, the proportion of women completing 4+ ANC visits was significantly lower during the voucher programme.Conclusions A positive association was observed between vouchers and facility-based deliveries in Nairobi. Although there is a need for higher quality evidence and validation in future studies, this statistically significant and policy relevant finding suggests that increases in facility-based deliveries can be achieved through output-based finance models that target subsidies to underserved populations. © The Author 2012; all rights reserved.
Authors & Co-Authors
Bellows, Benjamin W.
Unknown Affiliation
Kyobutungi, Catherine K.
Unknown Affiliation
Mutua, Martin Kavao
Unknown Affiliation
Warren, Charlotte E.
Unknown Affiliation
Ezeh, Alex Chika
Unknown Affiliation
Statistics
Citations: 88
Authors: 5
Affiliations: 3
Identifiers
Doi:
10.1093/heapol/czs030
e-ISSN:
14602237
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya
Participants Gender
Female