Background
Cambodia- Output Based Approach (OBA) to Social Health Insurance
Methods/Design
Hypotheses to be tested
(i) At facility level
(ii) At population level
Study Objectives
Study Design
OD pairs | Operational District(s) | Province | Control Voucher | Donor | Implementer | Operator | Start date | Total population |
---|---|---|---|---|---|---|---|---|
1 | Kampong Thom | Kampong Thom | Voucher | HSSP/WB | AFH | AFH | Oct-05 | 264,140 |
1 | Kampong Cham-Kampong Siem | Kampong Cham | Control | BTC | BTC | AFH | Sep-05 | 129,860 |
2 | Stong | Kampong Thom | Voucher | HSSP/WB | AFH | AFH | Oct-07 | 140,733 |
2 | Kralanh | Siem Reap | Control | BTC | BTC | CHHRA | Apr-06 | 136,520 |
3 | Preah Sdach | Prey Veng | Voucher | HSSP/ADB | URC-CHS | AFH | Sep-08 | 114,788 |
3 | Samrong | Oddor Mean Chey | Control | BTC | BTC | CHHRA | Jan-05 | 105,488 |
4 | Pearaing | Prey Veng | Voucher | HSSP/ADB | URC-CHS | AFH | Jul-02 | 188,230 |
4 | Svay Rieng | Svay Reing | Control | UNICEF | UNICEF | HFSC | Jul-02 | 311,473 |
5 | Kampong Trach | Kampot | Voucher | Government | ODO | ODO | Jan-08 | 163,362 |
5 | Angkor Chey | Kampot | Control | Government | ODO | ODO | Jan-08 | 117,325 |
6 | Kampong Trabek | Prey Veng | Voucher | Government | ODO | ODO | Jan-08 | 134,163 |
6 | Romeas Hek | Svay Reing | Control | Government | ODO | ODO | Jan-08 | 137,056 |
7 | Chhouk | Kampot | Voucher | 189,566 | ||||
7 | Kepville | Kep | Control | 33,306 | ||||
8 | Baray Santuk | Kompong Thom | Voucher | 243,435 | ||||
8 | O Reang Ov - Kaoh Soutin | Kampong Cham | Control | 103,258 | ||||
9 | Prey Veng | Prey Veng | Voucher | 212,689 | ||||
9 | Neak Loeung | Prey Veng | Control | 185,283 |
Facilities
Service providers
Key informants
CPI surveys of quality of care for reproductive health care consultations
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Are accessing maternity care including postnatal care, for themselves (and/or their newborns), at delivery or one of the pre-discharge, six-week postpartum consultation times;
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Are aged 18 years or older (the small proportion of clients that are less than 18 years will not justify the difficulties in obtaining parental/guardian permission for legal minors);
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Are aged below 46 years (the small proportion of women giving birth above this age will be excluded);
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Give their informed consent for their consultation to be observed and the key actions taken recorded, and to be interviewed on exiting from the consultation.
Client exit interviews
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Are accessing family planning, abortion, or essential maternity care including ANC, PNC, for themselves (and/or their babies), at pre-discharge following delivery and six-week postpartum consultation times;
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Are aged 18 years or older;
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Are aged below 46 years;
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Provide consent for exit interview.
Population survey respondents
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Used family planning or delivered in the last one year preceding the survey.
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Are aged over 18 years (the small proportion of clients that are less than 18 years will not justify the difficulties in obtaining parental/guardian permission for legal minors);
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Are aged below 46 years (the small proportion of women giving birth/accessing FP above this age will be excluded);
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Provide consent for interviews.
Sample size
Selection process of survey respondents
Data Collection Procedures
To Assess the effect of the Voucher on increasing access to, quality of, and reducing inequities in the use of, selected RH services
a) Undertake health facility assessments: measuring quality of MNH/RH and other services over time
i) Facility inventory
ii) Collecting service statistics
iii) Interviews with service providers
iv) Observation of client-provider interactions (CPI)
Quality of: | Observed provider actions: |
---|---|
a. Client - provider rapport (0-7) | Client greeted warmly, Discussed medical conditions, Asked if client understood information, Encouraged client to ask questions, Used client's name, Help in decision-making, Consultation time > 15 minutes |
b. ANC counseling | Birth planning, danger signs, physical and laboratory examinations, vitamin A capsule, iron tablet/syrup, TT vaccination, infant feeding, fertility intentions |
c. PNC counseling on danger signs since childbirth (0-10) | Ask about: bleeding since birth, color/smell of vaginal discharge, condition of perineum/CS scar, fever, headache or blurred vision, swelling in face, hands or feet, signs of thrombophlebitis, tiredness or breathlessness, convulsions or fits, LAM, breastfeeding |
v) Client exit interviews
vi) In-depth interviews with key informants
Evaluate the impact of the voucher and accreditation (V&A) approach on improving RH behaviors and RH status and reducing the inequities at the population level
a) Population based survey
Objective 1: To evaluate the impact of the V&A approach on improving reproductive health behaviors and status and reducing inequities at the population level | ||
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Results | Indicators | Data source |
Increase in clients using maternal health care services including poor women | Clients received ANC services from public health facility Clients received institutional safe delivery care (normal/vacuum/forceps/caesarean section) Clients received pregnancy related complications management from the designated facility Clients utilized PNC services Clients received facility-based care for managing life threatening complications Clients received key physical and laboratory examinations (weight, height, blood test, urine test, abdomen exam, sonogram or ultrasound, and anemia exam). | Service statistics Population survey |
Improved attitudes of service providers towards poor women | Providers indicating non discriminatory attitudes Clients recommending services to others | Client exit interview CPI Population survey |
Improved quality of services | Service waiting hours Round-the-clock service availability Maintaining privacy and confidentiality Availability of necessary service equipments and logistics | Client provider interaction Client exit interview Facility inventory |
Reduced out-of-pocket expenses | Medicine cost Transport cost Unofficial charge by the providers | Population survey |
Reduced disease burden | Proportion of untreated complicated pregnancies | Population survey |
Objective 2: To assess the effect of the V&A approach on increasing access to, quality of, and reducing inequities in the use of selected RH services
| ||
Results
|
Indicators
|
Data source
|
Increased knowledge and skills of service providers on maternal health care issues | Recite proper schedule of TT and child immunization Life-threatening complications management Referral conditions for life-threatening conditions | Interviews with service providers |
Increased awareness of clients on maternal health care issues among all clients and poor clients | Complications during pregnancy, delivery and post-partum period Number of ANC visits and schedule Schedule of Vitamin A capsule and iron tablet or syrup Schedule of TT and child immunization Breastfeeding | Population survey |
Increased utilization of maternal health care services | Clients received ANC services from public health facility Clients received institutional safe delivery care (normal/vacuum/forceps/caesarean section) Clients received pregnancy related complications management from the designated facility Clients utilized PNC services Clients received facility-based care for managing life threatening complications Clients received key physical and laboratory examinations (weight, height, blood test, urine test, abdomen exam, sonogram or ultrasound, and anemia exam). | Population survey |
Improved patient satisfaction with health care experiences | Perceived barriers to accessing services: costs, distance, quality, waiting times, privacy, confidentiality, respect, stigma surrounding service | Population survey Client exit interview |