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Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study

BACKGROUND: We evaluated the effects and financial costs of two interventions with respect to utilisation of institutional deliveries and other maternal health services in Oyam District in Uganda. METHODS: We conducted a quasi-experimental study involving intervention and comparable/control sub-coun...

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Autores principales: Massavon, William, Wilunda, Calistus, Nannini, Maria, Majwala, Robert Kaos, Agaro, Caroline, De Vivo, Emanuela, Lochoro, Peter, Putoto, Giovanni, Criel, Bart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737523/
https://www.ncbi.nlm.nih.gov/pubmed/29258475
http://dx.doi.org/10.1186/s12884-017-1623-y
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author Massavon, William
Wilunda, Calistus
Nannini, Maria
Majwala, Robert Kaos
Agaro, Caroline
De Vivo, Emanuela
Lochoro, Peter
Putoto, Giovanni
Criel, Bart
author_facet Massavon, William
Wilunda, Calistus
Nannini, Maria
Majwala, Robert Kaos
Agaro, Caroline
De Vivo, Emanuela
Lochoro, Peter
Putoto, Giovanni
Criel, Bart
author_sort Massavon, William
collection PubMed
description BACKGROUND: We evaluated the effects and financial costs of two interventions with respect to utilisation of institutional deliveries and other maternal health services in Oyam District in Uganda. METHODS: We conducted a quasi-experimental study involving intervention and comparable/control sub-counties in Oyam District for 12 months (January–December 2014). Participants were women receiving antenatal care, delivery and postnatal care services. We evaluated two interventions: the provision of (1) transport vouchers to women receiving antenatal care and delivering at two health centres (level II) in Acaba sub-county, and (2) baby kits to women who delivered at Ngai Health Centre (level III) in Ngai sub-county. The study outcomes included service coverage of institutional deliveries, four antenatal care visits, postnatal care, and the percentage of women ‘bypassing’ maternal health services inside their resident sub-counties. We calculated the effect of each intervention on study outcomes using the difference in differences analysis. We calculated the cost per institutional delivery and the cost per unit increment in institutional deliveries for each intervention. RESULTS: Overall, transport vouchers had greater effects on all four outcomes, whereas baby kits mainly influenced institutional deliveries. The absolute increase in institutional deliveries attributable to vouchers was 42.9%; the equivalent for baby kits was 30.0%. Additionally, transport vouchers increased the coverage of four antenatal care visits and postnatal care service coverage by 60.0% and 49.2%, respectively. ‘Bypassing’ was mainly related to transport vouchers and ranged from 7.2% for postnatal care to 11.9% for deliveries. The financial cost of institutional delivery was US$9.4 per transport voucher provided, and US$10.5 per baby kit. The incremental cost per unit increment in institutional deliveries in the transport-voucher system was US$15.9; the equivalent for the baby kit was US$30.6. CONCLUSION: The transport voucher scheme effectively increased utilisation of maternal health services whereas the baby-kit scheme was only effective in increasing institutional deliveries. The transport vouchers were less costly than the baby kits in the promotion of institutional deliveries. Such incentives can be sustainable if the Ministry of Health integrates them in the health system. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1623-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-57375232017-12-21 Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study Massavon, William Wilunda, Calistus Nannini, Maria Majwala, Robert Kaos Agaro, Caroline De Vivo, Emanuela Lochoro, Peter Putoto, Giovanni Criel, Bart BMC Pregnancy Childbirth Research Article BACKGROUND: We evaluated the effects and financial costs of two interventions with respect to utilisation of institutional deliveries and other maternal health services in Oyam District in Uganda. METHODS: We conducted a quasi-experimental study involving intervention and comparable/control sub-counties in Oyam District for 12 months (January–December 2014). Participants were women receiving antenatal care, delivery and postnatal care services. We evaluated two interventions: the provision of (1) transport vouchers to women receiving antenatal care and delivering at two health centres (level II) in Acaba sub-county, and (2) baby kits to women who delivered at Ngai Health Centre (level III) in Ngai sub-county. The study outcomes included service coverage of institutional deliveries, four antenatal care visits, postnatal care, and the percentage of women ‘bypassing’ maternal health services inside their resident sub-counties. We calculated the effect of each intervention on study outcomes using the difference in differences analysis. We calculated the cost per institutional delivery and the cost per unit increment in institutional deliveries for each intervention. RESULTS: Overall, transport vouchers had greater effects on all four outcomes, whereas baby kits mainly influenced institutional deliveries. The absolute increase in institutional deliveries attributable to vouchers was 42.9%; the equivalent for baby kits was 30.0%. Additionally, transport vouchers increased the coverage of four antenatal care visits and postnatal care service coverage by 60.0% and 49.2%, respectively. ‘Bypassing’ was mainly related to transport vouchers and ranged from 7.2% for postnatal care to 11.9% for deliveries. The financial cost of institutional delivery was US$9.4 per transport voucher provided, and US$10.5 per baby kit. The incremental cost per unit increment in institutional deliveries in the transport-voucher system was US$15.9; the equivalent for the baby kit was US$30.6. CONCLUSION: The transport voucher scheme effectively increased utilisation of maternal health services whereas the baby-kit scheme was only effective in increasing institutional deliveries. The transport vouchers were less costly than the baby kits in the promotion of institutional deliveries. Such incentives can be sustainable if the Ministry of Health integrates them in the health system. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1623-y) contains supplementary material, which is available to authorized users. BioMed Central 2017-12-19 /pmc/articles/PMC5737523/ /pubmed/29258475 http://dx.doi.org/10.1186/s12884-017-1623-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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 Research Article
Massavon, William
Wilunda, Calistus
Nannini, Maria
Majwala, Robert Kaos
Agaro, Caroline
De Vivo, Emanuela
Lochoro, Peter
Putoto, Giovanni
Criel, Bart
Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study
title Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study
title_full Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study
title_fullStr Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study
title_full_unstemmed Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study
title_short Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study
title_sort effects of demand-side incentives in improving the utilisation of delivery services in oyam district in northern uganda: a quasi-experimental study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737523/
https://www.ncbi.nlm.nih.gov/pubmed/29258475
http://dx.doi.org/10.1186/s12884-017-1623-y
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