Understanding Changes in Supply and Demand in Reproductive Health

impact evaluation;vouchers;kenya;operations research;health systems;unmet need;reproductive health;not listed

Sachathep, KarampreetGray, Ronald H. ;

Johns Hopkins University

关键词: impact evaluation;    vouchers;    kenya;    operations research;    health systems;    unmet need;    reproductive health;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39289/SACHATHEP-DISSERTATION-2014.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Objective. To understand the impact and equity implications of a Reproductive Health (RH) Voucher Program in Kenya, as well as to examine levels and trends of stated barriers to contraceptive use and its associations with fertility trends.Methods. Data were from household surveys from the Voucher Program in Kenya as well as the DHS, and World Bank Human Development Indicators. In the first paper logistic regression models were employed to assess the impact of the Vouchers on utilization of RH services. The second paper involved the calculation of concentration indices and curves of family planning method use as well as a decomposition of a concentration index of the utilization of specific family planning methods. The final paper involved fixed effects regressions of global trends of fertility to assess associations between stated barriers to contraceptive use and total fertility rates. Results. Once all factors were accounted for, subsidized vouchers in Kenya had no impact on utilization of facility based deliveries or the uptake of long-acting and permanent contraceptive methods (LAPMs). Those residing in voucher areas however had a much higher odds of having heard of LAP methods. Vouchers were seen to be effective in pro-poor targeting efforts.At an aggregate global level, we find that reductions in proximate stated barriers to utilization of family planning methods, such as women who have stated not having knowledge of methods, those who have health concerns, and those whom believe they do not need contraception due to infrequency of sex, all show strong correlations with changes in total fertility rates over time. Conclusions. Vouchers are being embraced as the solution to health system access issues worldwide; however, we find that impact on RH service use is limited on Kenyan populations and hence closer scrutiny is required in order to better understand whether these programs work in all contexts. At a macro-level, we find that proximate barriers to family planning method use may serve as better predictors of changes in total fertility trends across countries and over time and that RH programs may be more effective if they are able to target these context specific barriers.