Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

Mardieh L. Dennis; Lenka Benova; Timothy Abuya; Matteo Quartagno; Ben Bellows; Oona M. R. Campbell

doi:10.1093/heapol/czz004

Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

Mardieh L. Dennis, Lenka Benova, Timothy Abuya, Matteo Quartagno, Ben Bellows, Oona M. R. Campbell

Sexual Health including HIV

Research output: Contribution to journal › A1: Web of Science-article

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 48h 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

Original language	English
Journal	Health Policy and Planning
Volume	34
Issue number	2
Pages (from-to)	120-131
Number of pages	12
ISSN	0268-1080
DOIs	https://doi.org/10.1093/heapol/czz004
Publication status	Published - 2019

Keywords

Continuity of Patient Care/statistics & numerical data
Cross-Sectional Studies
Delivery, Obstetric/economics
Female
Humans
Insurance, Health/statistics & numerical data
Kenya
Maternal Health Services/economics
Parity
Postnatal Care/economics
Pregnancy
Prenatal Care/economics
Socioeconomic Factors
Surveys and Questionnaires

Access to Document

10.1093/heapol/czz004

Cite this

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title = "Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya",

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 48h 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",

keywords = "Continuity of Patient Care/statistics & numerical data, Cross-Sectional Studies, Delivery, Obstetric/economics, Female, Humans, Insurance, Health/statistics & numerical data, Kenya, Maternal Health Services/economics, Parity, Postnatal Care/economics, Pregnancy, Prenatal Care/economics, Socioeconomic Factors, Surveys and Questionnaires",

author = "Dennis, {Mardieh L.} and Lenka Benova and Timothy Abuya and Matteo Quartagno and Ben Bellows and Campbell, {Oona M. R.}",

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Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya. / Dennis, Mardieh L.; Benova, Lenka; Abuya, Timothy; Quartagno, Matteo; Bellows, Ben; Campbell, Oona M. R.

In: Health Policy and Planning, Vol. 34, No. 2, 2019, p. 120-131.

Research output: Contribution to journal › A1: Web of Science-article

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T1 - Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

AU - Dennis, Mardieh L.

AU - Benova, Lenka

AU - Abuya, Timothy

AU - Quartagno, Matteo

AU - Bellows, Ben

AU - Campbell, Oona M. R.

N1 - NPP; © The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

PY - 2019

Y1 - 2019

N2 - 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 48h 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

AB - 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 48h 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

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KW - Cross-Sectional Studies

KW - Delivery, Obstetric/economics

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KW - Humans

KW - Insurance, Health/statistics & numerical data

KW - Kenya

KW - Maternal Health Services/economics

KW - Parity

KW - Postnatal Care/economics

KW - Pregnancy

KW - Prenatal Care/economics

KW - Socioeconomic Factors

KW - Surveys and Questionnaires

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DO - 10.1093/heapol/czz004

M3 - A1: Web of Science-article

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JO - Health Policy and Planning

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