Use and misuse of a discount voucher scheme as a subsidy for insecticide-treated nets for malaria control in southern Tanzania
Use and misuse of a discount voucher scheme as a subsidy for insecticide-treated nets for malaria control in southern Tanzania
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DOI：
10.1093/heapol/czj005
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发表时间：
2006-01-01
影响因子：
3.2
通讯作者：
Schellenberg, JRMA
中科院分区：
文献类型：
--
作者：
Tami, A;Mbati, J;Schellenberg, JRMA
自 1997 年以来，坦桑尼亚南部的两个农村地区开始使用驱虫蚊帐 (ITN) 折扣券，作为向 5 岁以下儿童和孕妇提供定向补贴的一种方式。我们通过对 104 张随机选择的优惠券进行后续研究，评估了折扣优惠券的适当使用和滥用。我们追踪了这些优惠券从最初在母婴健康 (MCH) 诊所发放到在销售代理处兑换的整个过程。我们发现，所有达到目标人群的代金券（100%，56/56）都被用来购买 ITN。此外，使用代金券购买的杀虫剂蚊帐中，94% 的使用者是妇女和 5 岁以下儿童。然而，高达 48% (50/104) 的优惠券在发放优惠券的诊所被滥用。然而，大规模滥用行为仅在 21 家诊所中的 3 家发生。尽管大多数妇女在怀孕期间睡在蚊帐下，但尽管该计划已广为人知，但在怀孕期间使用代金券补贴的驱虫蚊帐的情况却很少。父母显然决定在孩子出生后而不是在怀孕期间购买补贴的 ITN。重要的是，20% 的家庭现有的唯一蚊帐是用代金券购买的。我们的研究结果表明，目标人群正确使用了代金券，为了最大限度地减少代金券泄漏，妇幼保健院需要采取控制措施，商业销售代理商在一定程度上也需要采取控制措施。提高整个社区对获得折扣券权利的认识也可能有助于控制医疗机构的滥用行为。
Since 1997, discount vouchers for insecticide-treated nets (ITNs) have been used in two rural districts of southern Tanzania as a way to target subsidies to children under 5 years and pregnant women. We assessed appropriate use and misuse of discount vouchers through a follow-up study of 104 randomly selected vouchers. We traced these vouchers from their original issue in mother-and-child health (MCH) clinics through to being redeemed at a sales agent. We found that all vouchers that reached the target population (100%, 56/56) were used to buy an ITN. Moreover, 94% of the ITNs bought with vouchers were used by those intended, women and children under 5 years. However, up to 48% (50/104) of the vouchers had been misused at the clinics that issued them. Nevertheless, large-scale misuse occurred only at three of 21 clinics. Although most women slept under a net while pregnant, the use of voucher-subsidized ITNs during pregnancy was low despite widespread knowledge of the scheme. Parents had apparently decided to buy the subsidized ITNs once the child was born and not during pregnancy. Importantly, in 20% of households the only existing net had been bought with a voucher. Our findings suggest that vouchers are properly used by the target population, and that to minimize voucher leakage, control measures are needed at MCH clinics and to a certain extent for commercial sales agents. Increased awareness among the whole community on the right to receive a discount voucher may also help to control misuse at health facilities.