1. Increased Coverage of Maternal Health Services among the Poor in Western Uganda in an Output-Based Aid Voucher Scheme
- Author
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Obare, Francis, Okwero, Peter, Villegas, Leslie, Mills, Samuel, and Bellows, Ben
- Subjects
SOCIAL SCIENCE ,ADOLESCENT REPRODUCTIVE HEALTH ,LOCAL POPULATION ,COMMERCIAL SEX ,ACCESS TO FAMILY PLANNING ,SAFE MOTHERHOOD ,IMPROVING HEALTH CARE ,MATERNAL HEALTH SERVICES ,CHILDREN ,CHILD HEALTH ,MEASUREMENT ,CONTRACEPTION ,HEALTH SYSTEM ,SEX WORKERS ,ADOLESCENTS ,IMPLEMENTATION ,SERVICE UTILIZATION ,EMERGENCY OBSTETRIC CARE ,POLICY MAKERS ,EMPOWERMENT OF WOMEN ,POOR MATERNAL HEALTH ,POPULATION ,IMMUNODEFICIENCY ,COMPLICATIONS ,REFERRAL FACILITY ,NUMBER OF CHILDREN ,WOMEN ,ACQUIRED IMMUNODEFICIENCY SYNDROME ,WORKERS ,REDUCING MATERNAL MORTALITY ,STIS ,MORTALITY RATIO ,SERVICE PROVIDERS ,FAMILY PLANNING PROGRAM ,DISEASES ,HEALTH OUTCOMES ,IMPROVEMENTS IN QUALITY OF CARE ,POPULATIONS ,HEALTH ,INTERVENTION ,HEALTH CARE SERVICES ,SEXUALLY TRANSMITTED DISEASES ,VIOLENCE ,BULLETIN ,SERVICE DELIVERY ,POLICY DISCUSSIONS ,NEONATAL MORTALITY ,PATIENT ,PUBLIC SERVICES ,SERVICE QUALITY ,LIVE BIRTHS ,MALARIA ,BABIES ,RURAL AREAS ,PURCHASING POWER ,FERTILITY ,NATIONAL HEALTH SYSTEMS ,HEALTH FACILITIES ,SERVICE PROVIDER ,PROGRESS ,MILLENNIUM DEVELOPMENT GOAL ,HYPERTENSION ,MORTALITY ,HEALTH-SECTOR ,LOW-INCOME COUNTRY ,DELIVERY CARE ,SOCIAL COHESION ,NATIONAL FAMILY PLANNING PROGRAMS ,DEVELOPMENT POLICY ,MATERNAL HEALTH ,RISKS ,INTERVIEW ,RISK GROUPS ,MATERNAL MORTALITY ,HEALTH SECTOR ,LEVEL OF EDUCATION ,QUALITY SERVICES ,DELIVERY COSTS ,HOUSEHOLD SURVEYS ,MARKETING ,PREGNANT WOMEN ,SKILLED HEALTH PERSONNEL ,NEWBORN ,INFORMED CONSENT ,COMMERCIAL SEX WORKERS ,ADOLESCENT HEALTH ,QUALITY OF HEALTH CARE ,WORLD HEALTH ORGANIZATION ,ANTENATAL CARE ,ABORTION ,HOME DELIVERIES ,HOUSEHOLD ASSETS ,LIFE EXPECTANCY ,MIDWIVES ,OBSTETRIC CARE ,HUMAN DEVELOPMENT ,MINISTRY OF HEALTH ,POPULATION COUNCIL ,REPRODUCTIVE HEALTH COMMODITIES ,WOMAN ,HEALTH POLICY ,NATIONAL FAMILY PLANNING ,FAMILY PLANNING PROGRAMS ,FOOD SECURITY ,POLICY ,HEALTH INDICATORS ,FAMILY PLANNING ,HEALTH PROBLEMS ,AIDS ,SEXUALLY TRANSMITTED INFECTIONS ,PREGNANCY ,NORMAL DELIVERIES ,HEALTH CARE ,HEALTH SYSTEMS ,MATERNAL HEALTH CARE ,NUTRITION ,SEX ,PUBLIC HEALTH ,SEXUAL PARTNER ,RESPECT ,CHILDBIRTH ,MATERNAL DEATHS ,EMERGENCY CARE ,NURSING ,REPRODUCTIVE HEALTH SERVICES ,TRAINING ,SERVICE PROVISION ,MATERNAL HEALTH OUTCOMES ,POPULATION STRATEGY ,LOW-INCOME POPULATIONS ,STERILIZATION ,POLICY RESEARCH ,DISEASE SYMPTOMS ,QUALITY OF SERVICES ,MORBIDITY ,DEVELOPING COUNTRIES ,FEMALE STERILIZATION ,CHILDBEARING ,PREGNANCY COMPLICATIONS ,FAMILY PLANNING SERVICES ,PREGNANCIES ,DRUGS ,INEQUITIES ,KNOWLEDGE ,CHILD HEALTH SERVICES ,STRATEGY ,POLICY RESEARCH WORKING PAPER ,MATERNAL MORTALITY RATIO ,REPRODUCTIVE HEALTH INDICATORS ,REPRODUCTIVE HEALTH CARE ,ACCESS TO HEALTH SERVICES ,SKILLED ATTENDANT ,USE OF MATERNAL HEALTH SERVICES ,RADIO ,MARITAL STATUS ,GENDER EQUALITY ,POLICY ANALYSIS ,PHARMACIES ,HIV ,MATERNAL MORBIDITY ,POSTNATAL CARE ,HEALTH SERVICES ,QUALITY OF CARE ,OBSERVATION ,CHILD MORTALITY ,CAESAREAN SECTION ,NEWBORN CARE ,INJURIES ,NURSES ,WEIGHT ,REPRODUCTIVE HEALTH ,PROVISION OF SERVICES ,HOSPITAL ,C-SECTION - Abstract
Vouchers stimulate demand for health care services by giving beneficiaries purchasing power. In turn, health facilities’ claims are reimbursed for providing beneficiaries with improved quality of health care. Efficient strategies to generate demand from new, often poor, users and supply in the form of increased access and expanded scope of services would help move Uganda away from inequity and toward universal health care. A reproductive health voucher program was implemented in 20 western and southwest Ugandan districts from April 2008 to March 2012. Using three years of data, this impact evaluation study employed a quasi-experimental design to examine differences in utilization of health services among women in voucher and nonvoucher villages. Two key findings were a 16-percentage-point net increase in private facility deliveries and a decrease in home deliveries among women who had used the voucher, indicating the project likely made contributions to increase private facility births in villages with voucher clients. No statistically significant difference was seen between respondents from voucher and nonvoucher villages in the use of postnatal care services, or in attending four or more antenatal care visits. A net 33-percentage-point decrease in out-of-pocket expenditure at private facilities in villages with voucher clients was found, and a higher percentage of voucher users came from households in the two poorest quintiles. The greater uptake of facility births by respondents in voucher villages compared with controls indicates that the approach has the potential to accelerate service uptake. A scaled program could help to move the country toward universal coverage of maternal health care.
- Published
- 2016