ArticleBMJ global health2018
Evaluating the impact of a maternal health voucher programme on service use before and after the introduction of free maternity services in Kenya: a quasi-experimental study.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review.Global health promotion · 2020Pooled it
- Quality and women's satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review.BMC pregnancy and childbirth · 2020Pooled it
- The Effects of a Reproductive Health Voucher Program on Out-of-Pocket Family Planning and Safe Motherhood Service Expenses: A Yemeni Study.Healthcare (Basel, Switzerland) · 2025Article
- Article
- Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review.PLOS global public health · 2024Article
- Factors related to women's use of health insurance cover in Navakholo, Kakamega County, Kenya: sub-county level results based on community household register.BMC public health · 2023Article
- Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya.PLOS global public health · 2023Article
- Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens.BMC pregnancy and childbirth · 2022Article
- Designing a Logic Model for Mobile Maternal Health e-Voucher Programs in Low- and Middle-Income Countries: An Interpretive Review.International journal of environmental research and public health · 2021Review
- Pro-poor policies and improvements in maternal health outcomes in India.BMC pregnancy and childbirth · 2021Article
- The impact of child health interventions and risk factors on child survival in Kenya, 1993-2014: a Bayesian spatio-temporal analysis with counterfactual scenarios.BMC medicine · 2021Article
- Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014.BMJ global health · 2021Article
- Health care workers' experiences of managing foetal distress and birth asphyxia at health facilities in Northern Uganda.Reproductive health · 2021Article
- Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya.BMC health services research · 2020Article
- Too poor or too far? Partitioning the variability of hospital-based childbirth by poverty and travel time in Kenya, Malawi, Nigeria and Tanzania.International journal for equity in health · 2020Article
- Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya.Health policy and planning · 2019Article
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7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionFrom 2006 to 2016, the Government of Kenya implemented a reproductive health voucher programme in select counties, providing poor women subsidised access to public and private sector care. In June 2013, the government introduced a policy calling for free maternity services to be provided in all public facilities. The concurrent implementation of these interventions presents an opportunity to provide new insights into how users adapt to a changing health financing and service provision landscape.
methodsWe used data from three cross-sectional surveys to assess changes over time in use of 4+ antenatal care visits, facility delivery, postnatal care and maternal healthcare across the continuum among a sample of predominantly poor women in six counties. We conducted a difference-in-differences analysis to estimate the impact of the voucher programme on these outcomes, and whether programme impact changed after free maternity services were introduced.
resultsBetween the preintervention/roll-out phase and full implementation, the voucher programme was associated with a 5.5% greater absolute increase in use of facility delivery and substantial increases in use of the private sector for all services. After free maternity services were introduced, the voucher programme was associated with a 5.7% higher absolute increase in use of the recommended package of maternal health services; however, disparities in access to facility births between voucher and comparison counties declined. Increased use of private sector services by women in voucher counties accounts for their greater access to care across the continuum.
conclusionsOur findings show that the voucher programme is associated with a modest increase in women's use of the full continuum of maternal health services at the recommended timings after free maternity services were introduced. The greater use of private sector services in voucher counties also suggests that there is need to expand women's access to acceptable and affordable providers.
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