Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya’s Safe Motherhood voucher scheme

Watt, Claire, Abuya, Timothy, Warren, Charlotte E., Obare, Francis, Kanya, Lucy ORCID: 0000-0003-4312-118X and Bellows, Ben (2015) Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya’s Safe Motherhood voucher scheme. PLOS ONE, 10 (4). ISSN 1932-6203

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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.

Item Type:	Article
Official URL:	http://journals.plos.org/plosone/
Additional Information:	© 2015 The Authors
Divisions:	Health Policy
Subjects:	H Social Sciences > HQ The family. Marriage. Woman R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Date Deposited:	07 Dec 2017 14:42
Last Modified:	20 Dec 2024 00:33
Projects:	: Evaluation of voucher and accreditation interventions for improving business models applied to reproductive health service delivery systems (Grant Number 51761)
Funders:	Bill & Melinda Gates Foundation
URI:	http://eprints.lse.ac.uk/id/eprint/86005

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