ArticleHealth policy and planning2019
Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya.
Article in Health policy and planning, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Private sector quality of care for maternal, new-born, and child health in low-and-middle-income countries: a secondary review.Frontiers in global women's health · 2024Pooled it
- The continuum of care for maternal health in Africa: A systematic review and meta-analysis.PloS one · 2024Pooled it
- Effects of women's economic empowerment interventions on antenatal care outcomes: a systematic review.BMJ open · 2023Pooled it
- Trial
- Completion of the maternal continuum of care in Kenya and Tanzania: role of quality antenatal care and other factors in a cross-sectional study.Research square · 2026Article
- Article
- Socioeconomic inequities impacting complete continuum of maternal healthcare service utilisation over time in Ethiopia.International journal of health economics and management · 2025Article
- Association of prognostic nutritional index and severe abdominal aortic calcification in middle-aged adults: a cross-sectional study.BMC cardiovascular disorders · 2025Article
- Trends and contributors of complete continuum of maternal healthcare service utilization in Ethiopia: a multivariate decomposition analyses.Reproductive health · 2025Article
- Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995-2019: a multi-country surveillance study of verbal autopsy data.The Lancet. Global health · 2024Article
- 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
- User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.ClinicoEconomics and outcomes research : CEOR · 2023Article
- Article
- Timely Initiation of Antenatal Care and Associated Factors among Pregnant Women Attending at Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia: A Cross-Sectional Study.Journal of pregnancy · 2023Article
- Health care providers' knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study.BMC pregnancy and childbirth · 2022Article
- Article
- Co-payments and equity in care: enhancing hospitalisation policy for Palestine refugees in Lebanon.BMC health services research · 2022Article
- No increase in use of hospitals for childbirth in Tanzania over 25 years: Accumulation of inequity among poor, rural, high parity women.PLOS global public health · 2022Article
- Completion and determinants of a continuum of care in maternal health services in Benishangul Gumuz region: A prospective follow-up study.Frontiers in public health · 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
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1.33, P = 0.014]. Early ANC initiation (aOR: 1.32, P = 0.001) and use of private sector ANC (aOR: 1.93, P < 0.001) were also positively associated with use of continuous care among ANC users. Among continuous care users, early ANC was associated with increased odds of completing the maternal health pathway as recommended (aOR: 3.80, P < 0.001). Higher parity was negatively associated with all three outcomes, while having health insurance was positively associated with each outcome. The impact of other sociodemographic factors such as maternal age, education, wealth quintile, urban residence, and employment varied by outcome; however, the findings generally suggest that marginalized women faced greater barriers to early ANC initiation and continuity of care. Health financing and women's timing and source of ANC are strongly related to their subsequent progression through the maternal health pathway. To increase continuity of care and improve maternal health outcomes, policymakers must therefore focus on equitably reducing financial and other barriers to care seeking and improving quality of care throughout the continuum.
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Registered trials
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