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肯尼亚免费生育政策的影响:一项中断时间序列分析。

Impact of free maternity policies in Kenya: an interrupted time-series analysis.

机构信息

Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya

Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya.

出版信息

BMJ Glob Health. 2021 Jun;6(6). doi: 10.1136/bmjgh-2020-003649.


DOI:10.1136/bmjgh-2020-003649
PMID:34108145
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8191610/
Abstract

BACKGROUND: User fees have been reported to limit access to services and increase inequities. As a result, Kenya introduced a free maternity policy in all public facilities in 2013. Subsequently in 2017, the policy was revised to the Linda Mama programme to expand access to private sector, expand the benefit package and change its management. METHODS: An interrupted time-series analysis on facility deliveries, antenatal care (ANC) and postnatal care (PNC) visits data between 2012 and 2019 was used to determine the effect of the two free maternity policies. These data were from 5419 public and 305 private and faith-based facilities across all counties, with data sourced from the health information system. A segmented negative binomial regression with seasonality accounted for, was used to determine the level (immediate) effect and trend (month-on-month) effect of the policies. RESULTS: The 2013 free-maternity policy led to a 19.6% and 28.9% level increase in normal deliveries and caesarean sections, respectively, in public facilities. There was also a 1.4% trend decrease in caesarean sections in public facilities. A level decrease followed by a trend increase in PNC visits was reported in public facilities. For private and faith-based facilities, there was a level decrease in caesarean sections and ANC visits followed by a trend increase in caeserean sections following the 2013 policy.Furthermore, the 2017 Linda Mama programme showed a level decrease then a trend increase in PNC visits and a 1.1% trend decrease in caesarean sections in public facilities. In private and faith-based facilities, there was a reported level decrease in normal deliveries and caesarean sections and a trend increase in caesarean sections. CONCLUSION: The free maternity policies show mixed effects in increasing access to maternal health services. Emphasis on other accessibility barriers and service delivery challenges alongside user fee removal policies should be addressed to realise maximum benefits in maternal health utilisation.

摘要

背景:有报道称,用户付费制度限制了服务的可及性,并加剧了不公平现象。因此,肯尼亚于 2013 年在所有公立医疗机构实施了免费产妇政策。随后,在 2017 年,该政策修订为“Linda Mama”计划,旨在扩大私营部门的服务范围,扩大福利范围,并改变其管理方式。

方法:本研究使用 2012 年至 2019 年期间医疗机构分娩、产前保健(ANC)和产后保健(PNC)就诊数据的中断时间序列分析来确定这两项免费产妇政策的效果。这些数据来自 5419 家公立和 305 家私立和宗教信仰医疗机构,数据来源于卫生信息系统。采用带季节性的分段负二项回归来确定政策的即时效应和逐月趋势效应。

结果:2013 年的免费产妇政策使公立医疗机构的正常分娩和剖宫产率分别提高了 19.6%和 28.9%。公立医疗机构的剖宫产率也呈现逐月下降的趋势。公立医疗机构的 PNC 就诊率呈现先下降后上升的趋势。对于私立和宗教信仰医疗机构,剖宫产和 ANC 就诊率先下降后上升,随后 2013 年政策实施后剖宫产率呈上升趋势。此外,2017 年的“Linda Mama”计划显示,公立医疗机构的 PNC 就诊率呈先下降后上升趋势,剖宫产率逐月下降 1.1%。私立和宗教信仰医疗机构的正常分娩和剖宫产率呈下降趋势,剖宫产率呈上升趋势。

结论:免费产妇政策在增加产妇保健服务的可及性方面效果喜忧参半。除了取消用户付费政策外,还应重视其他可及性障碍和服务提供方面的挑战,以实现产妇保健利用的最大效益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/c3c9824d61a6/bmjgh-2020-003649f04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/e74b518fba30/bmjgh-2020-003649f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/e35628709543/bmjgh-2020-003649f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/c8c2c43e44ef/bmjgh-2020-003649f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/c3c9824d61a6/bmjgh-2020-003649f04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/e74b518fba30/bmjgh-2020-003649f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/e35628709543/bmjgh-2020-003649f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/c8c2c43e44ef/bmjgh-2020-003649f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c35/8191610/c3c9824d61a6/bmjgh-2020-003649f04.jpg

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本文引用的文献

[1]
Examining the implementation of the Linda Mama free maternity program in Kenya.

Int J Health Plann Manage. 2021-11

[2]
Effects of implementing free maternity service policy in Kenya: an interrupted time series analysis.

BMC Health Serv Res. 2019-9-6

[3]
Effect of strikes by health workers on mortality between 2010 and 2016 in Kilifi, Kenya: a population-based cohort analysis.

Lancet Glob Health. 2019-5-22

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Interrupted time series analysis of free maternity services policy in Nyamira County, Western Kenya.

PLoS One. 2019-5-8

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Tackling health professionals' strikes: an essential part of health system strengthening in Kenya.

BMJ Glob Health. 2018-11-28

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The impact of reducing and eliminating user fees on facility-based delivery: a controlled interrupted time series in Burkina Faso.

Health Policy Plan. 2018-10-1

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Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation.

Int J Health Policy Manag. 2018-7-1

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Acta Obstet Gynecol Scand. 2018-6

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BMC Pregnancy Childbirth. 2018-3-27

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Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa.

BMJ Glob Health. 2018-1-3

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