Oyugi Boniface, Kioko Urbanus, Kaboro Stephen Mbugua, Gikonyo Shadrack, Okumu Clarice, Ogola-Munene Sarah, Kalsi Shaminder, Thiani Simon, Korir Julius, Odundo Paul, Baltazaar Billy, Ranji Moses, Muraguri Nicholas, Nzioka Charles
University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya.
OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
BMC Health Serv Res. 2017 Mar 27;17(1):236. doi: 10.1186/s12913-017-2164-9.
The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility.
The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17.
All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning.
The study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.
本研究旨在评估基于产出的方法（OBA）设施内采用OBA方法和未采用OBA方法的客户在获得长期计划生育（LTFP）方法方面的差异。
本研究采用准实验设计。使用方差不等的双尾非配对t检验来检验平均获得率的显著差异。通过利用两个或多个维度上的组间差异，进行长期计划生育方法项目效果的差异中的差异（DiD）估计，以估计因果效应。本研究还使用线性回归模型来评估长期计划生育方法选择的预测因素。使用SPSS 17版对数据进行分析。
所有方法（双侧输卵管结扎术-BTL、输精管切除术、宫内节育器-IUCD、植入物以及全部或联合长期计划生育方法-LTFP）在OBA客户与未采用OBA方法的客户之间的平均使用率上均显示出统计学显著差异。差异中的差异估计表明，OBA客户与未采用OBA方法的客户在获得率上的差异可显著归因于OBA项目在宫内节育器（p = 0.002）、植入物（p = 0.004）以及全部或联合长期计划生育方法（p = 0.001）方面的实施。居住县是除输精管切除术外所有长期计划生育方法获得率的一个重要决定因素，而登记年份是获得率的一个重要决定因素，尤其是对于植入物以及全部或联合长期计划生育方法。管理级别和机构类型在确定首选的长期计划生育方法类型方面不起作用；然而，作为管理级别的非政府组织（NGO）会影响除输精管切除术外所有方法（双侧输卵管结扎术、宫内节育器、植入物以及联合方法）的选择。代表各种模型所解释方差百分比的调整R值，对于植入物以及全部或联合长期计划生育方法大于18%。
该研究表明，肯尼亚的代金券服务在提供长期计划生育服务以及改善向育龄妇女提供的护理可及性方面是有效的。因此，代金券计划可作为弥合肯尼亚计划生育未满足需求差距的一种工具，如果推广到其他县可能会更有效。
