Maternal and child health voucher scheme in Myanmar: a review of early stage implementation.

Songyot Pilasant,Sripen Tantivess,Sangay Wangmo,Yot Teerawattananon,Nattha Tritasavit,Inthira Yamabhai,Pitsaphun Werayingyong,Wantanee Kulpeng

doi:10.1186/s12913-016-1850-3

Abstract

BackgroundThe Maternal and Child Health Voucher Scheme (MCHVS) was introduced in Myanmar to address the high rate of maternal and infant mortalities. It aimed to increase access to maternal and child health (MCH) services by skilled birth attendants (SBAs) and improve the health of pregnant women and their babies. A study to pilot a voucher scheme was implemented in May 2013 in Yedarshey Township. This paper provides a report on a mid-term review of the programme after 7 months of implementation to determine the outcomes of the programme and its impediments.MethodsQuantitative and qualitative approaches were used. Secondary quantitative data were analysed in order to measure the coverage and utilisation of the programme. Semi-structured interviews were conducted in groups and individually with 79 key informants to explore qualitative information on voucher communication, beneficiary’s identification, voucher distribution, and challenges for beneficiaries and providers under the MCHVS.ResultsThe results showed that 63 % of eligible pregnant women who registered to the programme received voucher booklets, while the utilisation of most of the MCH services increased over time; in particular, delivery by SBAs increased significantly (P < 0.01) after implementing MCHVS. Overall, the programme was implemented well in terms of promoting and communicating the programme to people in Yedarshey Township. Although a number of targeted poor pregnant women were included in the programme, some beneficiaries were overlooked for a variety of reasons. Nevertheless, both providers and beneficiaries who experienced the MCHVS service utilisation were satisfied with the programme. The evaluation indicated several programme challenges, i.e. external and internal programme communication, voluntary voucher distributor recruitment, incentive and support for voucher distributors, beneficiary screening criteria, and approaches to increase access of services for pregnant women living in remote areas.ConclusionsGenerally, the MCHVS pilot programme is a promising initiative to increase access to and utilisation of the MCH services for pregnant women and their babies in Myanmar. However, increasing coverage of the programme and overcoming the barriers should be considered as high-priority issues that need to be addressed.

Highlights

The Maternal and Child Health Voucher Scheme (MCHVS) was introduced in Myanmar to address the high rate of maternal and infant mortalities
The data, including name and level of health facilities, monthly incidence of pregnancy cases, number of vouchers distributed to registered pregnant women, number of pregnant women coming to receive the first antenatal care (ANC), delivery, and postnatal care (PNC) by skilled birth attendants (SBAs), and number of infants who had been vaccinated, between January and December 2013 were collected from all health facilities in Yedarshey Township; these facilities include one maternal and child health clinic and eight rural health centres (RHCs)
Voucher coverage The number of pregnant women who registered for the pilot programme in nine facilities between June and October 2013 (Table 2) amounted to 2,137

Summary

Introduction

The Maternal and Child Health Voucher Scheme (MCHVS) was introduced in Myanmar to address the high rate of maternal and infant mortalities. It aimed to increase access to maternal and child health (MCH) services by skilled birth attendants (SBAs) and improve the health of pregnant women and their babies. Myanmar faces many challenges in implementing health interventions, especially strongly encouraging pregnant women, mothers, and children who live in rural remote areas to utilise maternal and child health (MCH) services [3]. Less than one-fourth (24.5 %) of pregnant women who lived in rural areas delivered their babies at health facilities. Under-five mortality rate and maternal morlity ratio were 56 per 1,000 live births and 220 per 100,000 live births, respectively [9]. The mortality trends decreased, the mortality rate was still far from achieving the Millennium Development Goal (MDG) 4 in reducing under-five mortality rate to 36 per 1,000 live births [10] and MDG 5 in reducing maternal mortality ratio to 130 per 100,000 live births [11]

Methods

Results

Discussion

Conclusion