Increased Coverage of Maternal Health Services among the Poor in Western Uganda in an Output-Based Aid Voucher Scheme
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World Bank, Washington, DC
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Vouchers stimulate demand for health
care services by giving beneficiaries purchasing power. In
turn, health facilities’ claims are reimbursed for providing
beneficiaries with improved quality of health care.
Efficient strategies to generate demand from new, often
poor, users and supply in the form of increased access and
expanded scope of services would help move Uganda away from
inequity and toward universal health care. A reproductive
health voucher program was implemented in 20 western and
southwest Ugandan districts from April 2008 to March 2012.
Using three years of data, this impact evaluation study
employed a quasi-experimental design to examine differences
in utilization of health services among women in voucher and
nonvoucher villages. Two key findings were a
16-percentage-point net increase in private facility
deliveries and a decrease in home deliveries among women who
had used the voucher, indicating the project likely made
contributions to increase private facility births in
villages with voucher clients. No statistically significant
difference was seen between respondents from voucher and
nonvoucher villages in the use of postnatal care services,
or in attending four or more antenatal care visits. A net
33-percentage-point decrease in out-of-pocket expenditure at
private facilities in villages with voucher clients was
found, and a higher percentage of voucher users came from
households in the two poorest quintiles. The greater uptake
of facility births by respondents in voucher villages
compared with controls indicates that the approach has the
potential to accelerate service uptake. A scaled program
could help to move the country toward universal coverage of
maternal health care.
Palabras clave
POPULATION STRATEGY, CHILD HEALTH, RISKS, ADOLESCENT REPRODUCTIVE HEALTH, REPRODUCTIVE HEALTH, NORMAL DELIVERIES, SEX WORKERS, LOCAL POPULATION, QUALITY OF SERVICES, MATERNAL MORBIDITY, CONTRACEPTION, INFORMED CONSENT, SKILLED HEALTH PERSONNEL, EMPOWERMENT OF WOMEN, FAMILY PLANNING PROGRAM, ANTENATAL CARE, QUALITY OF HEALTH CARE, LOW-INCOME POPULATIONS, LIVE BIRTHS, MORBIDITY, SEXUALLY TRANSMITTED DISEASES, REDUCING MATERNAL MORTALITY, DEVELOPING COUNTRIES, PUBLIC SERVICES, HOME DELIVERIES, HEALTH CARE, DRUGS, ACQUIRED IMMUNODEFICIENCY SYNDROME, NATIONAL FAMILY PLANNING, SEXUALLY TRANSMITTED INFECTIONS, HEALTH, POLICY DISCUSSIONS, REPRODUCTIVE HEALTH INDICATORS, PROVISION OF SERVICES, DELIVERY COSTS, HYPERTENSION, IMPROVING HEALTH CARE, FAMILY PLANNING PROGRAMS, HEALTH FACILITIES, HOSPITAL, PUBLIC HEALTH, LIFE EXPECTANCY, MATERNAL MORTALITY, INEQUITIES, HEALTH SECTOR, KNOWLEDGE, PHARMACIES, MINISTRY OF HEALTH, DISEASES, MILLENNIUM DEVELOPMENT GOAL, PREGNANCIES, TRAINING, STERILIZATION, PATIENT, INTERVENTION, SEXUAL PARTNER, HEALTH INDICATORS, HEALTH SYSTEMS, REPRODUCTIVE HEALTH CARE, REFERRAL FACILITY, NATIONAL FAMILY PLANNING PROGRAMS, NURSES, STIS, HEALTH CARE SERVICES, OBSERVATION, VIOLENCE, ACCESS TO HEALTH SERVICES, MARKETING, REPRODUCTIVE HEALTH COMMODITIES, SERVICE PROVIDER, SAFE MOTHERHOOD, HOUSEHOLD SURVEYS, SERVICE PROVISION, MATERNAL HEALTH OUTCOMES, COMMERCIAL SEX WORKERS, SERVICE DELIVERY, HEALTH-SECTOR, INTERVIEW, HOUSEHOLD ASSETS, MATERNAL HEALTH CARE, MORTALITY, RADIO, RISK GROUPS, RESPECT, PROGRESS, SKILLED ATTENDANT, CHILDBIRTH, DISEASE SYMPTOMS, PREGNANCY COMPLICATIONS, FOOD SECURITY, WORKERS, QUALITY OF CARE, CAESAREAN SECTION, LOW-INCOME COUNTRY, HIV, MATERNAL HEALTH SERVICES, POSTNATAL CARE, IMMUNODEFICIENCY, WOMAN, POLICY RESEARCH WORKING PAPER, POOR MATERNAL HEALTH, POLICY MAKERS, HEALTH POLICY, PURCHASING POWER, HEALTH OUTCOMES, IMPROVEMENTS IN QUALITY OF CARE, FAMILY PLANNING, SOCIAL SCIENCE, POPULATION COUNCIL, MEASUREMENT, USE OF MATERNAL HEALTH SERVICES, NUTRITION, SERVICE UTILIZATION, SERVICE QUALITY, POPULATIONS, INJURIES, QUALITY SERVICES, MALARIA, ADOLESCENTS, BULLETIN, CHILDBEARING, POLICY, WORLD HEALTH ORGANIZATION, CHILD MORTALITY, MATERNAL MORTALITY RATIO, HEALTH SYSTEM, FEMALE STERILIZATION, BABIES, DELIVERY CARE, SEX, WEIGHT, PREGNANT WOMEN, MATERNAL HEALTH, REPRODUCTIVE HEALTH SERVICES, COMMERCIAL SEX, CHILDREN, LEVEL OF EDUCATION, MORTALITY RATIO, MATERNAL DEATHS, HEALTH PROBLEMS, MIDWIVES, RURAL AREAS, NUMBER OF CHILDREN, ACCESS TO FAMILY PLANNING, SOCIAL COHESION, POPULATION, MARITAL STATUS, NEONATAL MORTALITY, POLICY RESEARCH, STRATEGY, FERTILITY, CHILD HEALTH SERVICES, WOMEN, EMERGENCY OBSTETRIC CARE, NEWBORN, FAMILY PLANNING SERVICES, EMERGENCY CARE, ADOLESCENT HEALTH, POLICY ANALYSIS, OBSTETRIC CARE, AIDS, COMPLICATIONS, HEALTH SERVICES, IMPLEMENTATION, PREGNANCY, ABORTION, NEWBORN CARE, C-SECTION, GENDER EQUALITY, NURSING, NATIONAL HEALTH SYSTEMS, SERVICE PROVIDERS, DEVELOPMENT POLICY, HUMAN DEVELOPMENT