Background
Output Based Aid Voucher Program in Kenya
Methods/Design
Hypotheses to be tested
Study Objectives
Specific Objectives
Study design
Areas of focus | Indicators |
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Knowledge
| Provider competence; patient recognition of signs and symptoms of illness |
Utilization
| RH service utilization, client load, client socio-economic profile, and market share for voucher and accreditation services; Proportion of RH services provided by accredited and non-accredited facilities at district level, by public and non-public sector |
Targeting
| Proportion of eligible people who received voucher; percent of voucher holders who meet poverty scores |
Quality
| RH service quality as measured by facility readiness; provider competence; information provision; compliance with norms; follow-up support; client perceptions; among others |
Costs
| out-of-pocket expenses; facility revenue and expenses on voucher services include willingness to pay |
Disease burden and health status
| proportion of complicated pregnancies; respondents' socio-demographic characteristics, health-seeking behaviors by health condition, RH conditions and behaviors relevant to the service being evaluated, experiences and perceptions of RH services received; measures of pregnancy and birth-related complications, unintended pregnancies, inter-birth intervals, reports of STI symptoms, contraceptive, and condom, lactational amenorrhea method (LAM) use, and attendance for antenatal, delivery and postnatal services |
Data collection procedures
a). Health Facility Assessments
i) Facility Inventory
ii) Review of service statistics
iii) Interviews with healthcare providers
iv) Observations of Client-Provider Interactions
v).Client exit interview
Quality of: | Observed provider actions: |
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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. FP method counseling (0-6) | Discuss reproductive intentions, discuss previous use of FP, Discuss 2 or more methods, provide choice regarding preferred method, discuss how chosen method works, explain (dis)/advantages of chosen method |
c. ANC counseling | Birth planning, danger signs, infant feeding, fertility intentions |
d. 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 |
b). Population Survey
1. to assess the effect of the voucher program on increasing access to, quality of, and reducing inequities | ||
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Results | Indicators | Data source |
Provision of services reported as acceptable by providers and clients | Clients received comprehensive ANC and PNC | Client exit |
Clients referred for complicated deliveries | Provider interview | |
Clients referred for other services | Population survey | |
Increase in clients using MNH/FP services including poor women | % clients accessing different service by socio-economic status | Service statistics Client exit & population survey |
Increase in FP clients accepting long term methods | % clients using LAPM | Service statistics |
Client exit & population survey | ||
Improved attitudes of service providers towards poor women | % Providers indicating non discriminatory attitudes | Provider interview |
% Clients recommending services to others | Population survey | |
2 Evaluate the impact of voucher program on RH behaviors, status and reducing inequities
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Results
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Indicators
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Data source
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Reduced incidence of unintended pregnancies | % women who become pregnant/%planned pregnancy | Client Exit |
% clients with correct knowledge of fertile period | Population survey | |
Increased duration of contraceptive use among all women and poor women | Among all respondents and subgroups of poor: | Population survey |
• Ever/Current use of FP method | ||
• Discontinuation FP rates in 12 months | ||
• Ability to achieve fertility goals | ||
Decreased stigmatization at community level of poor women | Perceived barriers to accessing services: costs, distance, quality, waiting times, stigma surrounding service | Population survey |
c).Qualitative study
Data Management and Analysis
Discussion
Ethical issues
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Aim of the study and methods to be used
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Institutional affiliations of the research
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Anticipated benefits and potential risks and follow-up of the study
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Discomfort it may cause
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Sensitive questions regarding sexual behavior, partners and condom use will be asked, though they may choose not to answer any questions
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Questionnaire administration will increase time at clinic
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Right to abstain from participating in the study, or to withdraw from it at any time, without reprisal
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Measures to ensure confidentiality of information provided
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Study numbers will be used on questionnaires to maintain anonymity of study participants
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No information will be divulged to partners or other third parties
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Monetary compensation will only be provided if participant has to travel for the interview
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Contact details of the study coordinator for any questions or concerns