Keya Kaji Tamanna, Bellows Benjamin, Rob Ubaidur, Warren Charlotte
1 Population Council, Washington, DC, USA.
2 Population Council, Lusaka, Zambia.
Int Q Community Health Educ. 2018 Jan;38(2):137-145. doi: 10.1177/0272684X17749568. Epub 2018 Jan 3.
To test a statistically significant change in delivery by medically trained providers following introduction of a demand-side financing voucher, a population-based quasi-experimental study was undertaken, with 3,300 mothers in 2010 and 3,334 mothers at follow-up in 2012 in government-implemented voucher program and control areas. Results found that voucher program was significantly associated with increased public health facility use (difference-in-differences (DID) 13.9) and significantly increased delivery complication management care (DID 13.2) at facility although a null effect was found in facility-based delivery increase. A subset analysis of the five well-functioning facilities showed that facility deliveries increased DID 5.3 percentage points. Quintile-based analysis of all facilities showed that facility delivery increased more than threefold in lower quintile households comparing to twofold in control sites. The program needs better targeting to the beneficiaries, ensuring available gynecologist-anesthetist pair and midwives, effective monitoring, and timely fund reimbursements to facilities.
为了测试在引入需求方融资代金券后，受过医学培训的提供者的分娩情况是否有统计学上的显著变化，我们开展了一项基于人群的准实验研究，2010年有3300名母亲参与，2012年在政府实施的代金券计划和对照地区对3334名母亲进行了随访。结果发现，代金券计划与公共卫生设施使用的增加显著相关（差异中的差异（DID）为13.9），并且在医疗机构中，分娩并发症管理护理显著增加（DID为13.2），尽管在基于机构的分娩增加方面未发现显著效果。对五个运作良好的机构进行的子集分析表明，机构分娩增加了5.3个百分点。对所有机构进行的基于五分位数的分析表明，与对照地区增加两倍相比，较低五分位数家庭的机构分娩增加了三倍多。该计划需要更好地瞄准受益人，确保有妇科医生-麻醉师组合和助产士，进行有效监测，并及时向机构报销费用。
