Abt Associates Inc, International Health, 4550 Montgomery Avenue, Suite 800N, Bethesda, MD 20814, USA.
Soc Sci Med. 2012 Apr;74(7):989-96. doi: 10.1016/j.socscimed.2011.11.030. Epub 2012 Jan 28.
With the ultimate goal of reducing maternal and neonatal mortality, many countries have recently adopted innovative financing mechanisms to encourage the use of professional maternal health services. The current study evaluates one such initiative - a pilot voucher program in Bangladesh. The program provides poor women with cash incentives and free access to antenatal, delivery, and postnatal care, as well as cash incentives for providers to offer these services. We conducted a household survey of 2208 women who delivered in the 6 months before the survey (conducted in 2009) in 16 intervention and 16 matched comparison sub-districts. Probit and linear regressions are used to analyze the effects of residing in voucher sub-districts on the use of professional maternal health services and associated out-of-pocket expenditures. Using information on birth history, we conducted sensitivity analyses employing difference-in-differences methods, comparing women's reported births before and after the program's initiation in the intervention and comparison sub-districts. We found that the program significantly increased the use of antenatal, delivery, and postnatal care with qualified providers. Compared to women in matched comparison sub-districts, women in intervention areas had a 46.4 percentage point higher probability of using a qualified provider and 13.6 percentage point higher probability of institutional delivery. They also paid approximately Taka 640 (US$ 9.43) less for maternal health services, equivalent to 64% of the sample's average monthly household expenditure per capita. No significant effect of vouchers was found on the rate of Cesarean section. Our findings therefore support voucher program expansion targeting the economically disadvantaged to improve the use of priority health services. The Bangladesh voucher program is a useful example for other developing countries interested in improving maternal health service utilization.
为了降低母婴死亡率，许多国家最近采用了创新的融资机制，鼓励使用专业的母婴保健服务。本研究评估了孟加拉国的一项试点代金券计划。该计划为贫困妇女提供现金奖励和免费的产前、分娩和产后护理，以及为提供者提供这些服务的现金奖励。我们对在调查前 6 个月（2009 年进行）在 16 个干预和 16 个匹配比较分区分娩的 2208 名妇女进行了家庭调查。使用 Probit 和线性回归分析了居住在代金券分区对使用专业母婴保健服务和相关自付费用的影响。利用生育史信息，我们采用差异法进行了敏感性分析，比较了干预和比较分区中妇女在计划启动前后报告的生育情况。我们发现该计划显著增加了使用合格提供者的产前、分娩和产后护理的比例。与匹配比较分区的妇女相比，干预地区的妇女使用合格提供者的可能性高 46.4 个百分点，选择机构分娩的可能性高 13.6 个百分点。她们还为母婴保健服务支付了大约 640 塔卡（9.43 美元），比样本中人均月家庭支出的平均值低 64%。代金券对剖腹产率没有显著影响。因此，我们的研究结果支持针对经济弱势群体扩大代金券计划，以提高优先卫生服务的使用。孟加拉国的代金券计划为其他有兴趣提高母婴保健服务利用率的发展中国家提供了一个有用的范例。
