Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya

<p>Abtsract</p> <p>Background</p> <p>Alternatives to the traditional 'supply-side' approach to financing service delivery are being explored. These strategies are termed results-based finance, demand-side health financing or output-based aid which includes a range of interventions that channel government or donor subsidies to the user rather than the provider. Initial pilot assessments of reproductive health voucher programs suggest that, they can increase access and use, reducing inequities and enhancing program efficiency and service quality. However, there is a paucity of evidence describing how the programs function in different settings, for various reproductive health services. Population Council, funded by the Bill and Melinda Gates Foundation, intends to generate evidence around the 'voucher and accreditation' approaches to improving the reproductive health of low income women in Kenya.</p> <p>Methods/Design</p> <p>A quasi-experimental study will investigate the impact of the voucher approach on improving reproductive health behaviors, reproductive health status and reducing inequities at the population level; and assessing the effect of vouchers on increasing access to, and quality of, and reducing inequities in the use of selected reproductive health services. The study comprises of four populations: facilities, providers, women of reproductive health age using facilities and women and men who have been pregnant and/or used family planning within the previous 12 months. The study will be carried out in samples of health facilities - public, private and faith-based in: three districts; Kisumu, Kiambu, Kitui and two informal settlements in Nairobi which are accredited to provide maternal and newborn health and family planning services to women holding vouchers for the services; and compared with a matched sample of non-accredited facilities. Health facility assessments (HFA) will be conducted at two stages to track temporal changes in quality of care and utilization. Facility inventories, structured observations, and client exit interviews will be used to collect comparable data across facilities. Health providers will also be interviewed and observed providing care. A population survey of about 3000 respondents will also be carried out in areas where vouchers are distributed and similar locations where vouchers are not distributed.</p

A cross-sectional study of COVID-19 impacts in culturally and linguistically diverse communities in greater Western Sydney, Australia

Abstracts Background This study explored the experiences of people from culturally and linguistically diverse (CALD) backgrounds in Greater Western Sydney, Australia, in selected livelihood items during COVID-19 and the perceived impacts of the pandemic on their lives. Methods A cross-sectional survey was used to collect data between 25 August and 30 September 2020 among CALD communities in Greater Western Sydney. Information was collected on respondents’ experiences in selected livelihood items, including housing, finances, safety, accessing social services and activities, finding work, food, clothing, and relationships during COVID-19 and the pandemic’s perceived impact on their lives. Descriptive and non-parametric statistics were used to analyze the data. Results One hundred and ninety-eight participants were included in the study, 45.5% male and 54.5% female. Many respondents reported their experience in the selected livelihood items as “worse” during COVID-19 at the time of the study. The feeling of safety was most disrupted, with 56% of respondents rating their experience as “worse”. This experience was followed by accessing social support group activities, with 50% of respondents stating their experience of using this service had worsened. The experience of accessing social services and financial situation was rated as “worse” by 41% of respondents. Experience in finding work, housing, and attending schools were all rated as “worse”. The median perceived impact of COVID-19 among respondents who rated their experience in the selected livelihood items as “worse” were statistically higher than those who rated their experience as the “same”. Respondents’ characteristics also predicted the perceived impact of COVID-19. Unemployed respondents were 3.53 (95% CI: 1.16–10.73, p = 0.026) times more likely to perceive the impact of COVID-19 on their lives as “high” compared to employed respondents. Conclusions The finding demonstrates that the “high” number of respondents had the same situation as before COVID-19 and highlights the level of resilience exhibited by CALD communities in the Australian context. It also suggests that services in Australia were good during the pandemic. However, enhanced policy and initiatives designed to meet the CALD population’s needs are required, particularly in the areas most reported to have been disrupted by changes associated with COVID-19. </jats:sec

Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions

Abstract Background Disrespect and abuse or mistreatment of women by health care providers in maternity settings has been identified as a key deterrent to women seeking delivery care. Mistreatment includes physical and verbal abuse, stigma and discrimination, a poor relationship between women and providers and policy and health systems challenges. This paper uses qualitative data to describe mistreatment of women in Kenya. Methods Data are drawn from implementation research conducted in 13 facilities and communities. Researchers conducted a range of in-depth interviews with women (n-50) who had given birth in a facility policy makers health managers and providers (n-63); and focus group discussions (19) with women and men living around study facilities. Data were captured on paper and audio tapes, transcribed and translated and exported into Nvivo for analysis. Subsequently we applied a typology of mistreatment which includes first order descriptive themes, second and third-order analytical themes. Final analysis was organized around description of the nature, manifestations and experiences, and factors contributing to mistreatment. Results Women describe: their negative experiences of childbirth; frustration with lack of confidentiality and autonomy; abandonment by the providers, and dirty maternity units. Providers admit to challenges but describe reasons for apparent abuse (slapped on thighs to encourage women to focus on birthing process) and ‘detention’ is because relatives have abandoned them. Men try to overcome challenges by paying providers to ensure they look after their wives. Drivers of mistreatment are perpetuated by social and gender norms at family and community levels. At facility level, poor managerial oversight, provider demotivation, and lack of equipment and supplies, contribute to a poor experience of care. Weak or non-existent legal redress perpetuate the problem. Conclusion This paper builds on the expanding literature on mistreatment during labour and childbirth –outlining drivers from an individual, family, community, facility and policy level. New frameworks to group the manifestations into themes or components makes it increasingly more focused on specific interventions to promote respectful maternity care. The Kenya findings resonate with budding literature – demonstrating that this is indeed a global issue that needs a global solution

A cross-sectional study of COVID-19 impacts in culturally and linguistically diverse communities in greater Western Sydney, Australia

Background: This study explored the experiences of people from culturally and linguistically diverse (CALD) backgrounds in Greater Western Sydney, Australia, in selected livelihood items during COVID-19 and the perceived impacts of the pandemic on their lives. Methods: A cross-sectional survey was used to collect data between 25 August and 30 September 2020 among CALD communities in Greater Western Sydney. Information was collected on respondents’ experiences in selected livelihood items, including housing, finances, safety, accessing social services and activities, finding work, food, clothing, and relationships during COVID-19 and the pandemic’s perceived impact on their lives. Descriptive and non-parametric statistics were used to analyze the data. Results: One hundred and ninety-eight participants were included in the study, 45.5% male and 54.5% female. Many respondents reported their experience in the selected livelihood items as “worse” during COVID-19 at the time of the study. The feeling of safety was most disrupted, with 56% of respondents rating their experience as “worse”. This experience was followed by accessing social support group activities, with 50% of respondents stating their experience of using this service had worsened. The experience of accessing social services and financial situation was rated as “worse” by 41% of respondents. Experience in finding work, housing, and attending schools were all rated as “worse”. The median perceived impact of COVID-19 among respondents who rated their experience in the selected livelihood items as “worse” were statistically higher than those who rated their experience as the “same”. Respondents’ characteristics also predicted the perceived impact of COVID-19. Unemployed respondents were 3.53 (95% CI: 1.16-10.73, p = 0.026) times more likely to perceive the impact of COVID-19 on their lives as “high” compared to employed respondents. Conclusions: The finding demonstrates that the “high” number of respondents had the same situation as before COVID-19 and highlights the level of resilience exhibited by CALD communities in the Australian context. It also suggests that services in Australia were good during the pandemic. However, enhanced policy and initiatives designed to meet the CALD population’s needs are required, particularly in the areas most reported to have been disrupted by changes associated with COVID-19

A cross-sectional study of COVID-19 impacts in culturally and linguistically diverse communities in greater Western Sydney, Australia

Background: This study explored the experiences of people from culturally and linguistically diverse (CALD) backgrounds in Greater Western Sydney, Australia, in selected livelihood items during COVID-19 and the perceived impacts of the pandemic on their lives. Methods: A cross-sectional survey was used to collect data between 25 August and 30 September 2020 among CALD communities in Greater Western Sydney. Information was collected on respondents’ experiences in selected livelihood items, including housing, finances, safety, accessing social services and activities, finding work, food, clothing, and relationships during COVID-19 and the pandemic’s perceived impact on their lives. Descriptive and non-parametric statistics were used to analyze the data. Results: One hundred and ninety-eight participants were included in the study, 45.5% male and 54.5% female. Many respondents reported their experience in the selected livelihood items as “worse” during COVID-19 at the time of the study. The feeling of safety was most disrupted, with 56% of respondents rating their experience as “worse”. This experience was followed by accessing social support group activities, with 50% of respondents stating their experience of using this service had worsened. The experience of accessing social services and financial situation was rated as “worse” by 41% of respondents. Experience in finding work, housing, and attending schools were all rated as “worse”. The median perceived impact of COVID-19 among respondents who rated their experience in the selected livelihood items as “worse” were statistically higher than those who rated their experience as the “same”. Respondents’ characteristics also predicted the perceived impact of COVID-19. Unemployed respondents were 3.53 (95% CI: 1.16-10.73, p = 0.026) times more likely to perceive the impact of COVID-19 on their lives as “high” compared to employed respondents. Conclusions: The finding demonstrates that the “high” number of respondents had the same situation as before COVID-19 and highlights the level of resilience exhibited by CALD communities in the Australian context. It also suggests that services in Australia were good during the pandemic. However, enhanced policy and initiatives designed to meet the CALD population’s needs are required, particularly in the areas most reported to have been disrupted by changes associated with COVID-19

Additional file 1 of A cross-sectional study of COVID-19 impacts in culturally and linguistically diverse communities in greater Western Sydney, Australia

Additional file 1. Relevant items developed for the current study