Studies that documented improved care-seeking indicated the importance of adequate programme scope ( in terms of programme eligibility , size and timing of payments and voucher entitlements ) to address the issue of concern , concurrent investments in supply-side capacity to sustain and /or improve quality of care , and awareness generation using community-based workers , leaders and women ’s groups .
Conclusions Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social , geographical and health systems factors as barriers to accessing care .
Background Dem and -side financing ( DSF ) interventions , including cash transfers and vouchers , have been introduced to promote maternal and newborn health in a range of low- and middle-income countries .
These interventions vary in design but have typically been used to increase health service utilisation by off setting some financial costs for users , or increasing household income and incentivising ‘ healthy behaviours ’ .
This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health .
Assessing the population-level impact of vouchers on access to health facility delivery for women in Kenya.
Although available evidence indicates that vouchers improve service utilization among the target population s , we do not know whether increased utilization results from improved access ( new clients who would not have used services without the voucher ) or from shifting clients from non-accredited to contracted service providers . This paper examines whether the  safe motherhood voucher program in Kenya is associated with improved access to health facility delivery using information on births within two years preceding the survey in voucher and comparison sites . Data were collected in 2010 - 2011 and in 2012 among 2933 and 3094 women aged 15 - 49 years reporting 962 and 1494 births within two years before the respective surveys . Analysis entails cross-tabulations and estimation of multilevel r and om-intercept logit models . The results show that the proportion of births occurring at home declined by more than 10 percentage points while the proportion of births delivered in health facilities increased by a similar margin over time in voucher sites . The increase in facility-based births occurred in both public and private health facilities . There was also a significant increase in the likelihood of facility-based delivery ( odds ratios [ OR ] : 2.04 ; 95 % confidence interval [ CI ] : 1.40 - 2.98 in the 2006 voucher arm ; OR : 1.72 ; 95 % CI : 1.22 - 2.43 in the 2010 - 2011 voucher arm ) in voucher sites over time . In contrast , there were no significant changes in the likelihood of facility-based delivery in the comparison arm over time . These findings suggest that the voucher program contributed to improved access to institutional delivery by shifting births from home to health facilities . However , available evidence from qualitative data shows that some women who purchased the vouchers did not use them because of high transportation costs to accredited facilities . The implication is that substantial improvements in service uptake could be achieved if the program subsidized transportation costs as well
Studies that documented improved care-seeking indicated the importance of adequate programme scope ( in terms of programme eligibility , size and timing of payments and voucher entitlements ) to address the issue of concern , concurrent investments in supply-side capacity to sustain and /or improve quality of care , and awareness generation using community-based workers , leaders and women ’s groups .
Conclusions Evaluations spanning more than 15 years of implementation of DSF programmes reveal a complex picture of experiences that reflect the importance of financial and other social , geographical and health systems factors as barriers to accessing care .
Background Dem and -side financing ( DSF ) interventions , including cash transfers and vouchers , have been introduced to promote maternal and newborn health in a range of low- and middle-income countries .
These interventions vary in design but have typically been used to increase health service utilisation by off setting some financial costs for users , or increasing household income and incentivising ‘ healthy behaviours ’ .
This article documents experiences and implementation factors associated with use of DSF in maternal and newborn health .