利用目标凭证和卫生公平基金改善贫困妇女获得熟练接生员服务的机会：柬埔寨三个农村卫生区的案例研究。
Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia.
机构信息
Provincial Health Department, Ministry of Health, Siem Reap, Cambodia.
出版信息
BMC Pregnancy Childbirth. 2010 Jan 7;10:1. doi: 10.1186/1471-2393-10-1.
BACKGROUND
In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up.
METHODS
Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation.
RESULTS
Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme.
CONCLUSIONS
Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.
背景
在许多发展中国家，孕产妇死亡率仍然很高，且贫富差距巨大。旨在改善孕产妇健康和预防孕产妇死亡的方案往往无法惠及贫困妇女。健康券和卫生公平基金（HEF）是改善贫困人群获得优先卫生服务的一种财政机制。我们评估了它们在提高柬埔寨三个农村卫生区贫困妇女获得熟练接生人员服务方面的有效性，并从中吸取经验教训，以进一步改进和扩大规模。
方法
从现有数据库、报告和常规卫生信息系统中提取了 2006 年至 2008 年期间利用券和 HEF 计划的数据以及在公立卫生机构分娩的数据。通过焦点小组讨论和关键知情人访谈收集了定性数据。我们检查了这三个卫生区 2006 年至 2008 年期间的设施分娩趋势，并将其与没有券和 HEF 计划的其他农村地区的情况进行了比较。对券计划进行了运营分析，以评估其在不同运营阶段的效果。
结果
券和 HEF 计划推出后，设施分娩率从 2006 年预计分娩数的 16.3%急剧上升到 2008 年的 44.9%，不仅惠及券和 HEF 的受益人群，也惠及自费分娩的人群。与缺乏券和 HEF 计划的可比地区相比，这一增长幅度要大得多。2008 年，券和 HEF 的受益人群占贫困人群预计分娩数的 40.6%。我们还概述了券计划的一些局限性。
结论
如果精心设计和实施，券加 HEF 具有很大的潜力，可以减少经济障碍，从而改善贫困妇女获得熟练接生人员的机会。为了充分发挥其潜力，券和 HEF 需要其他干预措施，以确保提供足够数量和质量的产妇服务，并解决需求方面的其他非经济障碍。如果满足这些条件，可以在密切监测和评估下进一步扩大券和 HEF 计划的规模。
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