健康券干预是否会增加喀麦隆的产前检查和熟练助产服务？一项中断时间序列分析的结果。

Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis.

机构信息

The Global Financing Facility (GFF), Dakar, Senegal.

Research for Development International, 30883, Yaoundé, Cameroon.

出版信息

BMC Health Serv Res. 2024 May 8;24(1):602. doi: 10.1186/s12913-024-10962-9.

DOI:10.1186/s12913-024-10962-9

PMID:38720364

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11080306/

Abstract

BACKGROUND

Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).

METHODS

Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.

RESULTS

Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.

CONCLUSIONS

Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.

摘要

背景

由于经济障碍，产前和分娩期间获得卫生服务的机会有限，这是降低孕产妇和儿童死亡率的障碍。为了改善喀麦隆三个地区的卫生服务利用情况，这三个地区的生殖、孕产妇、新生儿、儿童和青少年健康指标最差，自 2015 年以来，一个旨在减少经济障碍的医疗券项目逐步在这三个地区实施。我们的研究旨在评估券计划对首次产前检查（ANC）和熟练接生（SBA）的影响。

方法

使用 2013 年 1 月至 2018 年 5 月期间每个纳入研究样本的 33 家和 37 家卫生机构的月度常规汇总数据，分别衡量券项目对首次 ANC 和 SBA 的影响。我们使用中断时间序列回归估计了干预措施对产出指标水平的直接影响，包括项目启动后立即和随着时间的推移。采用荟萃分析获得总体估计值。

结果

总体而言，券项目在项目启动后一个月内立即产生了显著的增长，每月 ANC 数量增加了 26%，每月 SBA 数量增加了 57%。与项目启动前相比，在项目实施期间，SBA 的每月增长具有统计学意义，但首次 ANC 没有。卫生机构（HFs）的结果参差不齐。一些 HFs 有所改善，而其他 HFs 则面临现状或下降。