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Working Paper

Increased Coverage of Maternal Health Services among the Poor in Western Uganda in an Output-Based Aid Voucher Scheme

POPULATION STRATEGY CHILD HEALTH RISKS ADOLESCENT REPRODUCTIVE HEALTH REPRODUCTIVE HEALTH NORMAL DELIVERIES SEX WORKERS LOCAL POPULATION QUALITY OF SERVICES MATERNAL MORBIDITY CONTRACEPTION INFORMED CONSENT SKILLED HEALTH PERSONNEL EMPOWERMENT OF WOMEN FAMILY PLANNING PROGRAM ANTENATAL CARE QUALITY OF HEALTH CARE LOW-INCOME POPULATIONS LIVE BIRTHS MORBIDITY SEXUALLY TRANSMITTED DISEASES REDUCING MATERNAL MORTALITY DEVELOPING COUNTRIES PUBLIC SERVICES HOME DELIVERIES HEALTH CARE DRUGS ACQUIRED IMMUNODEFICIENCY SYNDROME NATIONAL FAMILY PLANNING SEXUALLY TRANSMITTED INFECTIONS HEALTH POLICY DISCUSSIONS REPRODUCTIVE HEALTH INDICATORS PROVISION OF SERVICES DELIVERY COSTS HYPERTENSION IMPROVING HEALTH CARE FAMILY PLANNING PROGRAMS HEALTH FACILITIES HOSPITAL PUBLIC HEALTH LIFE EXPECTANCY MATERNAL MORTALITY INEQUITIES HEALTH SECTOR KNOWLEDGE PHARMACIES MINISTRY OF HEALTH DISEASES MILLENNIUM DEVELOPMENT GOAL PREGNANCIES TRAINING STERILIZATION PATIENT INTERVENTION SEXUAL PARTNER HEALTH INDICATORS HEALTH SYSTEMS REPRODUCTIVE HEALTH CARE REFERRAL FACILITY NATIONAL FAMILY PLANNING PROGRAMS NURSES STIS HEALTH CARE SERVICES OBSERVATION VIOLENCE ACCESS TO HEALTH SERVICES MARKETING REPRODUCTIVE HEALTH COMMODITIES SERVICE PROVIDER SAFE MOTHERHOOD HOUSEHOLD SURVEYS SERVICE PROVISION MATERNAL HEALTH OUTCOMES COMMERCIAL SEX WORKERS SERVICE DELIVERY HEALTH-SECTOR INTERVIEW HOUSEHOLD ASSETS MATERNAL HEALTH CARE MORTALITY RADIO RISK GROUPS RESPECT PROGRESS SKILLED ATTENDANT CHILDBIRTH DISEASE SYMPTOMS PREGNANCY COMPLICATIONS FOOD SECURITY WORKERS QUALITY OF CARE CAESAREAN SECTION LOW-INCOME COUNTRY HIV MATERNAL HEALTH SERVICES POSTNATAL CARE IMMUNODEFICIENCY WOMAN POLICY RESEARCH WORKING PAPER POOR MATERNAL HEALTH POLICY MAKERS HEALTH POLICY PURCHASING POWER HEALTH OUTCOMES IMPROVEMENTS IN QUALITY OF CARE FAMILY PLANNING SOCIAL SCIENCE POPULATION COUNCIL MEASUREMENT USE OF MATERNAL HEALTH SERVICES NUTRITION SERVICE UTILIZATION SERVICE QUALITY POPULATIONS INJURIES QUALITY SERVICES MALARIA ADOLESCENTS BULLETIN CHILDBEARING POLICY WORLD HEALTH ORGANIZATION CHILD MORTALITY MATERNAL MORTALITY RATIO HEALTH SYSTEM FEMALE STERILIZATION BABIES DELIVERY CARE SEX WEIGHT PREGNANT WOMEN MATERNAL HEALTH REPRODUCTIVE HEALTH SERVICES COMMERCIAL SEX CHILDREN LEVEL OF EDUCATION MORTALITY RATIO MATERNAL DEATHS HEALTH PROBLEMS MIDWIVES RURAL AREAS NUMBER OF CHILDREN ACCESS TO FAMILY PLANNING SOCIAL COHESION POPULATION MARITAL STATUS NEONATAL MORTALITY POLICY RESEARCH STRATEGY FERTILITY CHILD HEALTH SERVICES WOMEN EMERGENCY OBSTETRIC CARE NEWBORN FAMILY PLANNING SERVICES EMERGENCY CARE ADOLESCENT HEALTH POLICY ANALYSIS OBSTETRIC CARE AIDS COMPLICATIONS HEALTH SERVICES IMPLEMENTATION PREGNANCY ABORTION NEWBORN CARE C-SECTION GENDER EQUALITY NURSING NATIONAL HEALTH SYSTEMS SERVICE PROVIDERS DEVELOPMENT POLICY HUMAN DEVELOPMENT
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World Bank, Washington, DC
Africa | Uganda
2016-07-07T16:00:11Z | 2016-07-07T16:00:11Z | 2016-06

Vouchers stimulate demand for health care services by giving beneficiaries purchasing power. In turn, health facilities’ claims are reimbursed for providing beneficiaries with improved quality of health care. Efficient strategies to generate demand from new, often poor, users and supply in the form of increased access and expanded scope of services would help move Uganda away from inequity and toward universal health care. A reproductive health voucher program was implemented in 20 western and southwest Ugandan districts from April 2008 to March 2012. Using three years of data, this impact evaluation study employed a quasi-experimental design to examine differences in utilization of health services among women in voucher and nonvoucher villages. Two key findings were a 16-percentage-point net increase in private facility deliveries and a decrease in home deliveries among women who had used the voucher, indicating the project likely made contributions to increase private facility births in villages with voucher clients. No statistically significant difference was seen between respondents from voucher and nonvoucher villages in the use of postnatal care services, or in attending four or more antenatal care visits. A net 33-percentage-point decrease in out-of-pocket expenditure at private facilities in villages with voucher clients was found, and a higher percentage of voucher users came from households in the two poorest quintiles. The greater uptake of facility births by respondents in voucher villages compared with controls indicates that the approach has the potential to accelerate service uptake. A scaled program could help to move the country toward universal coverage of maternal health care.

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