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Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme

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  • Claire Watt
  • Timothy Abuya
  • Charlotte E Warren
  • Francis Obare
  • Lucy Kanya
  • Ben Bellows

Abstract

This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

Suggested Citation

  • Claire Watt & Timothy Abuya & Charlotte E Warren & Francis Obare & Lucy Kanya & Ben Bellows, 2015. "Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-20, April.
    • Handle: RePEc:plo:pone00:0122828
    DOI: 10.1371/journal.pone.0122828
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    References listed on IDEAS

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    2. Anderson, Michael L, 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Department of Agricultural & Resource Economics, UC Berkeley, Working Paper Series qt15n8j26f, Department of Agricultural & Resource Economics, UC Berkeley.
    3. Anderson, Michael L., 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Journal of the American Statistical Association, American Statistical Association, vol. 103(484), pages 1481-1495.
    4. M. R. Bhatia & A. C. Gorter, 2007. "Improving access to reproductive and child health services in developing countries: are competitive voucher schemes an option?," Journal of International Development, John Wiley & Sons, Ltd., vol. 19(7), pages 975-981.
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    1. Kuwawenaruwa, August & Ramsey, Kate & Binyaruka, Peter & Baraka, Jitihada & Manzi, Fatuma & Borghi, Josephine, 2019. "Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation," Social Science & Medicine, Elsevier, vol. 225(C), pages 17-25.
    2. Yeoh, Eng-Kiong & Yam, Carrie H.K. & Chong, Ka-Chun & Chow, Tsz-Yu & Fung, Valerie L.H. & Wong, Eliza L.Y. & Griffiths, Sian M., 2020. "An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey coh," Health Policy, Elsevier, vol. 124(2), pages 189-198.
    3. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.

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