Abstract
BackgroundHigh fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.Methods/DesignThis study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as ‘Suraj’ (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period.DiscussionThe study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.
Highlights
High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas
The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers
This approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, among the poorest socio-economic group
Summary
High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. Demand-side financing/voucher programme typically engage the private sector, ensuring minimum quality standards to accredit facilities and encourage providers who do not qualify to make improvements to become eligible [8]. This introduces greater competition among providers, thereby increasing supply and improving consumers’ choice [9]. Performance-based financing (PBF) – or ‘pay-4-performance’ or ‘output-based aid (OBA)’ – generally consists of a range of methods and approaches aimed at linking incentives to performance [10] They have been used in many countries [11,12], and are gaining increasing attention as a way of achieving national goals in low-income countries [10,13]
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