A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya

Background Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women’s access to quality Safe...
Ausführliche Beschreibung

Background Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women’s access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya’s programme accredited health facilities in three districts as well as in two informal Nairobi settlements. Methods Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 and in similar non-voucher health facilities (n = 20) are compared with cross sectional data collected in 2010. Summary scores for quality were calculated as additive sums of specific aspects of each attribute (structure, process, outcome). Measures of effect were assessed in a linear regression model accounting for clustering at facility level. Data were analysed using Stata 11.0. Results The overall quality of postnatal care is poor in voucher and non-voucher facilities, but many facilities demonstrated ‘readiness’ for postnatal care (structural attributes: infrastructure, equipment, supplies, staffing, training) indicated by high scores (83/111), with public voucher facilities scoring higher than public non-voucher facilities. The two groups of facilities evinced no significant differences in postnatal care mean process scores: 14.2/55 in voucher facilities versus 16.4/55 in non-voucher facilities; coefficient: -1.70 (-4.9, 1.5), p = 0.294. Significantly more newborns were seen within 48 hours (83.5 % versus 72.1 %: p = 0.001) and received Bacillus Calmette-Guerin (BCG) (82.5 % versus 76.5 %: p < 0.001) at voucher facilities than at non-voucher facilities. Conclusions Four years after facility accreditation in Kenya, scores for postnatal care quality are low in all facilities, even those with Safe Motherhood vouchers. We recommend the Kenya OBA programme review its Safe Motherhood reimbursement package and draw lessons from supply side results-based financing initiatives, to improve postnatal care quality. Ausführliche Beschreibung

Autor*in:	Warren, Charlotte E [verfasserIn] Abuya, Timothy Kanya, Lucy Obare, Francis Njuki, Rebecca Temmerman, Marleen Bellows, Ben

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2015

Schlagwörter:	Postnatal care Vvoucher OBA Quality of care Structure Process and outcome

Anmerkung:	© Warren et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (

Übergeordnetes Werk:	Enthalten in: BMC pregnancy and childbirth - London : BioMed Central, 2001, 15(2015), 1 vom: 24. Juli
Übergeordnetes Werk:	volume:15 ; year:2015 ; number:1 ; day:24 ; month:07

Links:	Volltext

DOI / URN:	10.1186/s12884-015-0588-y

Katalog-ID:	SPR027577791