Abstract
BackgroundThe study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility.MethodsThe study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17.ResultsAll the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R2 value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning.ConclusionThe study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.
Highlights
The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility
The study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age
Total aFacilities in Nyando have been combined with the Kisumu, and Mwingi has been combined with Kitui study is based on the quantitative analysis of an existing data collected by the Voucher Management Agency (VMA) (National coordinating agency on population and development) of the OBA project in Kenya from 2008 to 2009, and existing data collected by the Voucher Management Agency (VMA) (Pricewaterhouse Coopers) from 2010 to 2015
Summary
The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility. In 2015, it was estimated that the contraceptives provided globally helped avert 34,000 maternal deaths, 4.4 million abortions (including 3.9 million unsafe ones), 12.3 million unintended pregnancies, and 220,000 child deaths [1]. Long term family planning (LTFP) methods such as intrauterine contraceptive devices (IUCDs), vasectomy, bilateral tubal ligation (BTL), and implants are current effective methods that prevents unwanted pregnancies [5]. LTFP are cost effective and when compared to short term methods such as injections and pills, result in fewer clinic visits and less unintended pregnancies; thereby, easing the burden on health systems and health providers [5, 6]. Demographic health surveys from Sub-Saharan Africa (SSA) shows that most women are using short term methods than the long-term family planning methods [7]. Several nations with poor resources have not yet achieved optimum levels of contraceptive and it is estimated that there is a 57% overall lack of contraceptive access within African countries [9]
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