Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study.
Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study.
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DOI：
10.1186/1472-698x-11-s1-s11
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发表时间：
2011-03-09
影响因子：
3
通讯作者：
Peters DH
中科院分区：
文献类型：
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作者：
Ekirapa-Kiracho E;Waiswa P;Rahman MH;Makumbi F;Kiwanuka N;Okui O;Rutebemberwa E;Bua J;Mutebi A;Nalwadda G;Serwadda D;Pariyo GW;Peters DH
地理位置不便、缺乏交通和财政负担是乌干达孕产妇保健服务需求方面的一些制约因素，而供应方面的问题包括与保健工作者缺乏积极性和供应不足有关的服务质量差。乌干达的大多数公共卫生干预措施只解决了选定的供应方问题，大学的工作重点是在三级医院提供孕产妇服务。为了展示马凯雷雷大学健康科学学院（MakCHS）的改革如何能够导致系统性变革，从而改善孕产妇保健服务，与当地社区和国家利益攸关方合作制定了供需方战略。这项准实验性试验在乌干达东部的两个地区进行。供应方面的组成部分包括保健工作者进修培训和增加最低限度的药品和用品，而需求方面的组成部分则包括向孕妇发放摩托车运输代金券和向产前、分娩和产后护理服务提供者付款。该试验正在进行中，但提出了常规卫生信息系统对所使用服务数量的早期分析。社区中的摩托车手组织起来接受代金券，以换取产前护理、分娩和产后护理的交通，并积极参与确保妇女获得护理。产前、分娩和产后护理都有所增加，干预地区的安全分娩数量立即从每月不到200例增加到干预部门的每月500例以上，税收收入用于购买所需用品，以提高质量，并支付保健工作人员的工资，确保在工作量增加时有他们。运输和服务券似乎是迅速增加产妇护理的可行战略。MakCHS可以与利益相关者一起设计战略，使用边做边学的方法来利用社区资源。
Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders. This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented. Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing. Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.