title: Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya.
abstract: 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 R2value, 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.
authors.affiliation: University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya. boyugi@uonbi.ac.ke.
authors.forename: Boniface
authors.initials: B
authors.lastname: Oyugi
authors.affiliation: University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya.
authors.forename: Urbanus
authors.initials: U
authors.lastname: Kioko
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Stephen Mbugua
authors.initials: SM
authors.lastname: Kaboro
authors.affiliation: University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya.
authors.forename: Shadrack
authors.initials: S
authors.lastname: Gikonyo
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Clarice
authors.initials: C
authors.lastname: Okumu
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ogola-Munene
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Shaminder
authors.initials: S
authors.lastname: Kalsi
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Simon
authors.initials: S
authors.lastname: Thiani
authors.affiliation: University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya.
authors.forename: Julius
authors.initials: J
authors.lastname: Korir
authors.affiliation: University of Nairobi Enterprise and Services Consultancy, Arboretum Drive, P.O BOX 68241-00200, Nairobi, Kenya.
authors.forename: Paul
authors.initials: P
authors.lastname: Odundo
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Billy
authors.initials: B
authors.lastname: Baltazaar
authors.affiliation: OBA Program Management Unit, Ministry of Health, Nairobi, Kenya.
authors.forename: Moses
authors.initials: M
authors.lastname: Ranji
authors.affiliation: Ministry of Health, Nairobi, Kenya.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Muraguri
authors.affiliation: Ministry of Health, Nairobi, Kenya.
authors.forename: Charles
authors.initials: C
authors.lastname: Nzioka
mesh_terms: D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D008297:Male; D015397:Program Evaluation; D055815:Young Adult
keywords: Long term family planning; Output Based Approach; Voucher system