title: Community-level impact of the reproductive health vouchers programme on service utilization in Kenya.
abstract: This paper examines community-level association between exposure to the reproductive health vouchers programme in Kenya and utilization of services. The data are from a household survey conducted among 2527 women (15-49 years) from voucher and comparable non-voucher sites. Analysis entails cross-tabulations with Chi-square tests and significant tests of proportions as well as estimation of multi-level logit models to predict service utilization by exposure to the programme. The results show that for births occurring after the voucher programme began, women from communities that had been exposed to the programme since 2006 were significantly more likely to have delivered at a health facility and to have received skilled care during delivery compared with those from communities that had not been exposed to the programme at all. There were, however, no significant differences in the timing of first trimester utilization of antenatal care (ANC) and making four or more ANC visits by exposure to the programme. In addition, poor women were significantly less likely to have used safe motherhood services (health facility delivery, skilled delivery care and postnatal care) compared with their non-poor counterparts regardless of exposure to the programme. Nonetheless, a significantly higher proportion of poor women from communities that had been exposed to the programme since 2006 used the services compared with their poor counterparts from communities that had not been exposed to the programme at all. The findings suggest that the programme is associated with increased health facility deliveries and skilled delivery care especially among poor women. However, it has had limited community-level impact on the first trimester timing of antenatal care use and making four or more visits, which remain a challenge despite the high proportion of women in the country that make at least one antenatal care visit during pregnancy.
authors.affiliation: Population Council, Ralph Bunche Road, P.O. Box 17643, Nairobi 00500, Kenya. fonyango@popcouncil.org
authors.forename: Francis
authors.initials: F
authors.lastname: Obare
authors.forename: Charlotte
authors.initials: C
authors.lastname: Warren
authors.forename: Rebecca
authors.initials: R
authors.lastname: Njuki
authors.forename: Timothy
authors.initials: T
authors.lastname: Abuya
authors.forename: Joseph
authors.initials: J
authors.lastname: Sunday
authors.forename: Ian
authors.initials: I
authors.lastname: Askew
authors.forename: Ben
authors.initials: B
authors.lastname: Bellows
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data; D011247:Pregnancy; D012111:Residence Characteristics / Q000706:statistics & numerical data; D055815:Young Adult