Abstract
BackgroundLow and middle income countries have adopted targeting mechanisms as a means of increasing program efficiency in reaching marginalized people in the community given the available resources. Design of targeting mechanisms has been changing over time and it is important to understand implementers’ experience with such targeting mechanisms since such mechanisms impact equity in access and use of maternal health care services.MethodsThe case study approach was considered as appropriate method for exploring implementers’ and decision-makers’ experiences with the two targeting mechanisms. In-depth interviews in order to explore implementer experience with the two targeting mechanisms. A total of 10 in-depth interviews (IDI) and 4 group discussions (GDs) were conducted with implementers at national level, regional, district and health care facility level. A thematic analysis approach was adopted during data analysis.ResultsThe whole process of screening and identifying poor pregnant women resulted in delay in implementation of the intervention. Individual targeting was perceived to have some form of stigmatization; hence beneficiaries did not like to be termed as poor. Geographical targeting had a few cons as health care providers experienced an increase in workload while staff remained the same and poor quality of information in the claim forms. However geographical targeting increase in the number of women going to higher level of care (district/regional referral hospital), increase in facility revenue and insurance coverage.ConclusionInterventions which are using targeting mechanisms to reach poor people are useful in increasing access and use of health care services for marginalized communities so long as they are well designed and beneficiaries as well as all implementers and decision makers are involved from the very beginning. Implementation of demand side financing strategies using targeting mechanisms should go together with supply side interventions in order to achieve project objectives.
Highlights
Low and middle income countries have adopted targeting mechanisms as a means of increasing program efficiency in reaching marginalized people in the community given the available resources
The screening process faced a lot of challenges especially at the community and health care facility level, where some of those who received the insurance card were not the real poor targeted by the intervention
A recent study undertaken by the World Bank and the World Health Organization (WHO) on the potential use of the community-directed intervention approach to carry out interventions showed that community level implementers expressed a desire for financial incentives; the lack of financial incentives did not have a significant effect on their willingness to serve [24]
Summary
Low and middle income countries have adopted targeting mechanisms as a means of increasing program efficiency in reaching marginalized people in the community given the available resources. In 2010, Tanzania’s National Health Insurance Fund (NHIF) and German Development Bank (KfW) used geographical and individual targeting mechanisms in Rungwe district to pilot a social health insurance program (MCH insurance card) for poor pregnant women. During antenatal care (ANC) visits women were informed of the program by the provider; thereafter they were given registration form and the score card. They go back to the village and presented the card to the village leaders who assessed them based on the screening criteria, the woman returned the score card to provider. Women scoring 8 – 18 qualified for the program (termed as “poor”) and were given the MCH insurance card and used it to access care from accredited health care facilities [8].
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