Cargando…

Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study

BACKGROUND: The use of demand-side financing mechanisms to increase health service utilisation among target groups and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is limited evidence on the effects of such schemes on equity, financial protecti...

Descripción completa

Detalles Bibliográficos
Autores principales: Borghi, Josephine, Ramsey, Kate, Kuwawenaruwa, August, Baraka, Jitihada, Patouillard, Edith, Bellows, Ben, Binyaruka, Peter, Manzi, Fatuma
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490646/
https://www.ncbi.nlm.nih.gov/pubmed/26141724
http://dx.doi.org/10.1186/s12913-015-0905-1
_version_ 1782379544867504128
author Borghi, Josephine
Ramsey, Kate
Kuwawenaruwa, August
Baraka, Jitihada
Patouillard, Edith
Bellows, Ben
Binyaruka, Peter
Manzi, Fatuma
author_facet Borghi, Josephine
Ramsey, Kate
Kuwawenaruwa, August
Baraka, Jitihada
Patouillard, Edith
Bellows, Ben
Binyaruka, Peter
Manzi, Fatuma
author_sort Borghi, Josephine
collection PubMed
description BACKGROUND: The use of demand-side financing mechanisms to increase health service utilisation among target groups and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is limited evidence on the effects of such schemes on equity, financial protection, quality of care, and cost-effectiveness. A scheme providing free health insurance cards to poor pregnant women and their households was first introduced in two regions of Tanzania in 2011 and gradually expanded in 2012. METHODS: A controlled before and after study will examine in one district the effect of the scheme on utilization, quality, and cost of healthcare services accessed by poor pregnant women and their households in Tanzania. Data will be collected 4 months before implementation of the scheme and 17 months after the start of implementation from a survey of 24 health facilities, 288 patients exiting consultations and 1500 households of women who delivered in the previous year in one intervention district (Mbarali). 288 observations of provider-client interactions will also be carried out. The same data will be collected from a comparison district in a nearby region. A process evaluation will ascertain how the scheme is implemented in practice and the level of implementation fidelity and potential moderators. The process evaluation will draw from impact evaluation data and from three rounds of data collection at the national, regional, district, facility and community levels. An economic evaluation will measure the cost-effectiveness of the scheme relative to current practice from a societal perspective. DISCUSSION: This evaluation will generate evidence on the impact and cost-effectiveness of targeted health insurance for pregnant women in a low income setting, as well as building a better understanding of the implementation process and challenges for programs of this nature.
format Online
Article
Text
id pubmed-4490646
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-44906462015-07-04 Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study Borghi, Josephine Ramsey, Kate Kuwawenaruwa, August Baraka, Jitihada Patouillard, Edith Bellows, Ben Binyaruka, Peter Manzi, Fatuma BMC Health Serv Res Study Protocol BACKGROUND: The use of demand-side financing mechanisms to increase health service utilisation among target groups and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is limited evidence on the effects of such schemes on equity, financial protection, quality of care, and cost-effectiveness. A scheme providing free health insurance cards to poor pregnant women and their households was first introduced in two regions of Tanzania in 2011 and gradually expanded in 2012. METHODS: A controlled before and after study will examine in one district the effect of the scheme on utilization, quality, and cost of healthcare services accessed by poor pregnant women and their households in Tanzania. Data will be collected 4 months before implementation of the scheme and 17 months after the start of implementation from a survey of 24 health facilities, 288 patients exiting consultations and 1500 households of women who delivered in the previous year in one intervention district (Mbarali). 288 observations of provider-client interactions will also be carried out. The same data will be collected from a comparison district in a nearby region. A process evaluation will ascertain how the scheme is implemented in practice and the level of implementation fidelity and potential moderators. The process evaluation will draw from impact evaluation data and from three rounds of data collection at the national, regional, district, facility and community levels. An economic evaluation will measure the cost-effectiveness of the scheme relative to current practice from a societal perspective. DISCUSSION: This evaluation will generate evidence on the impact and cost-effectiveness of targeted health insurance for pregnant women in a low income setting, as well as building a better understanding of the implementation process and challenges for programs of this nature. BioMed Central 2015-07-04 /pmc/articles/PMC4490646/ /pubmed/26141724 http://dx.doi.org/10.1186/s12913-015-0905-1 Text en © Borghi et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Study Protocol
Borghi, Josephine
Ramsey, Kate
Kuwawenaruwa, August
Baraka, Jitihada
Patouillard, Edith
Bellows, Ben
Binyaruka, Peter
Manzi, Fatuma
Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
title Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
title_full Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
title_fullStr Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
title_full_unstemmed Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
title_short Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
title_sort protocol for the evaluation of a free health insurance card scheme for poor pregnant women in mbeya region in tanzania: a controlled-before and after study
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490646/
https://www.ncbi.nlm.nih.gov/pubmed/26141724
http://dx.doi.org/10.1186/s12913-015-0905-1
work_keys_str_mv AT borghijosephine protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT ramseykate protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT kuwawenaruwaaugust protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT barakajitihada protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT patouillardedith protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT bellowsben protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT binyarukapeter protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy
AT manzifatuma protocolfortheevaluationofafreehealthinsurancecardschemeforpoorpregnantwomeninmbeyaregionintanzaniaacontrolledbeforeandafterstudy