scholarly journals Evaluating the impact of a maternal health voucher programme on service use before and after the introduction of free maternity services in Kenya: a quasi-experimental study

2018 ◽  
Vol 3 (2) ◽  
pp. e000726 ◽  
Author(s):  
Mardieh L Dennis ◽  
Timothy Abuya ◽  
Oona Maeve Renee Campbell ◽  
Lenka Benova ◽  
Angela Baschieri ◽  
...  
Keyword(s):  
Maternal Health ◽  
Private Sector ◽  
Maternal Health Services ◽  
Facility Delivery ◽  
Absolute Increase ◽  
Maternity Services ◽  
Poor Women ◽  
The Government ◽  
The Impact ◽  
The Continuum

IntroductionFrom 2006 to 2016, the Government of Kenya implemented a reproductive health voucher programme in select counties, providing poor women subsidised access to public and private sector care. In June 2013, the government introduced a policy calling for free maternity services to be provided in all public facilities. The concurrent implementation of these interventions presents an opportunity to provide new insights into how users adapt to a changing health financing and service provision landscape.MethodsWe used data from three cross-sectional surveys to assess changes over time in use of 4+ antenatal care visits, facility delivery, postnatal care and maternal healthcare across the continuum among a sample of predominantly poor women in six counties. We conducted a difference-in-differences analysis to estimate the impact of the voucher programme on these outcomes, and whether programme impact changed after free maternity services were introduced.ResultsBetween the preintervention/roll-out phase and full implementation, the voucher programme was associated with a 5.5% greater absolute increase in use of facility delivery and substantial increases in use of the private sector for all services. After free maternity services were introduced, the voucher programme was associated with a 5.7% higher absolute increase in use of the recommended package of maternal health services; however, disparities in access to facility births between voucher and comparison counties declined. Increased use of private sector services by women in voucher counties accounts for their greater access to care across the continuum.ConclusionsOur findings show that the voucher programme is associated with a modest increase in women’s use of the full continuum of maternal health services at the recommended timings after free maternity services were introduced. The greater use of private sector services in voucher counties also suggests that there is need to expand women’s access to acceptable and affordable providers.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

scholarly journals Improving maternal health services through social accountability interventions in Nepal:  An analytical review of existing literature

2019 ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Grey Literature ◽  
Maternal Health Services ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background: The persistent equity and quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. The Government of Nepal has emphasized on responsive and accountable maternal health services since 2005, while social accountability interventions have been commenced as a strategical approach. This review is an attempt to critically explore the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute informed policy. Methods: A literature review and desk study were done between December 2018 to May 2019. An adapted framework of social accountability by Lodenstein et al. 2013 was used for critical analysis and synthesis of the existing literature from Nepal and other low- and middle-income countries (LMICs). The literature was searched and extracted from the search engines i.e. google and google scholar using keywords. The searched includes both published and grey literature. Results: The review found different social accountability interventions initiated by the government and external development partners in maternal health services in Nepal. The evidence from Nepal and other LMICs showed that the social accountability interventions improve the quality of maternal health services through improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. The strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions: The evidence show that social accountability interventions have the potential to improve the quality of maternal health services in Nepal. Critical factors of successful outcomes in maternal health services include quality implementation of the interventions. Similarly, continuous effort is needed from policymaker to strengthen monitoring and regulatory mechanism of the health system and decentralization, improve access to the information and establishment of proper channels to capture complaints and feedback from the community to ensure the effectiveness of the interventions for the long run. Furthermore, research is needed to evaluate the impact of the existing social accountability interventions in the reduction of maternal mortality in Nepal.

Impact of Mandatory Medical Insurance on Construction Contractors in Saudi Arabia

2010 ◽  
Vol 163-167 ◽  
pp. 4529-4534 ◽  
Author(s):  
Abdullah M Alsugair
Keyword(s):  
Saudi Arabia ◽  
Private Sector ◽  
Construction Projects ◽  
Medical Insurance ◽  
Company Performance ◽  
Medical Needs ◽  
Medical Facilities ◽  
Comprehensive Development ◽  
The Government ◽  
The Impact

The comprehensive development in Saudi Arabia forced the private sector to bring foreign employees to assist in accomplishing this development. The number of foreign employees reached to six million people according to the late statistics. This huge number of people exerted pressure on the public free medical facilities that forced the government to issue a decree that instructs private sector to use private medical facilities for their foreign employees. The private sector dealt with this decree in different ways according to the perception of the company from providing full medical coverage for their employees to providing nothing. This has created a problem to many foreigners in which they have to pay for their medical needs. The government, then, issued a new decree that is the mandatory medical insurance. This decree requires the private sector to provide full medical coverage for their foreign employees. This decree will have an impact on the construction companies (contractors) and the cost of the construction projects. This paper presents results of a study conducted to identify the impact of the mandatory medical insurance on the construction contractors in Saudi Arabia. The methodology used was to prepare a questionnaire that investigates the objectives of this study and distributes it to the contractors. The questionnaire includes many aspects among them the impact of this decree on the company performance and the competition between contractors; how this extra expense being dealt with; and the impact on the employee. The questionnaires were distributed to 150 construction contractors and 90 questionnaires were collected. Results of the study reveal the impact of the mandatory medical insurance on the construction contractors in general and according to their classifications. In addition, the study presents the current practice implemented by contractors to provide medical care for their foreign employees.

The impact of open government data on accountability and transparency

2018 ◽  
Vol 34 (3) ◽  
pp. 204-216 ◽  
Author(s):  
Stuti Saxena ◽  
Irfan Muhammad
Keyword(s):  
Private Sector ◽  
Citizen Participation ◽  
Open Government ◽  
Data Sets ◽  
Structured Interviews ◽  
Content Type ◽  
Open Government Data ◽  
Government Data ◽  
The Government ◽  
The Impact

Purpose Accountability, citizen participation and transparency are the three pillars on which open government data (OGD) is based. As such, OGD implies that the government shall provide data freely via the internet so that the same may be re-used for diverse purposes. It is hoped that by re-using government data, public value shall be co-created and government services might be improved upon with the involvement of different stakeholders. The purpose of this paper is to underline the impact of OGD on accountability and transparency in the context of Pakistan where OGD initiative is taking roots for quite some time now. In the present study, the authors seek to investigate the challenges being faced by the professionals in the private sector and nongovernment organizations (NGOs) in Pakistan. Besides, the authors also seek inputs from the respondents in the manner in which OGD initiative of Pakistan has impact on ensuring accountability and transparency. Design/methodology/approach For conducting the review of the national OGD portal of Pakistan, the authors invoke documentary analysis wherein the authors investigate the features of the national OGD portal of Pakistan. Furthermore, the authors conducted structured interviews with 49 senior management representatives from private sector and NGOs in order to gauge the challenges encountered by them in tapping OGD from diverse online public sources. Findings Respondents aver that robust statistical analysis is not feasible via the data sets being shared by the online sources. More initiatives are required on the part of the government bodies to release the data sets which have remained confined in silos. Government should institutionalize an OGD policy and promote the re-use of OGD by the professionals from diverse backgrounds. At present, only educational data are being shared by the OGD portal of Pakistan and it is important that more data sets are being released in the public domain. Furthermore, the respondents perceive that in a bid to be more accountable and transparent, the government bodies should release data sets via the online channels which are user-friendly. Research limitations/implications The present study conducted a qualitative research where the number of respondents was relatively less. Further research is required by adopting quantitative approach in order to accommodate more respondents and lend reliability to the study. Nevertheless, the study holds implications for academicians and practitioners in the sense that while it is needed that further research be conducted on the OGD initiative of Pakistan, it is imperative that policy makers get involved in institutionalizing the OGD initiative of Pakistan at national and local levels. Social implications Professionals might be better involved in creating and co-creating products and services by tapping OGD. Originality/value Given that OGD initiative in Pakistan is in a nascent stage and research is wanting in exploring the nature and scope of Pakistan’s OGD, the present study seeks to contribute toward the existing OGD literature.

Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

2019 ◽  
Author(s):  
Ruth Atuhaire
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Facility ◽  
Structural Equation ◽  
First Trimester ◽  
Maternal Health Services ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Mediating Factor

Abstract Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

Looking at the bigger picture: effect of performance-based contracting of district health services on equity of access to maternal health services in Zambia

2019 ◽  
Author(s):  
Collins Chansa ◽  
Mulenga Mary Mukanu ◽  
Chitalu Miriam Chama-Chiliba ◽  
Mpuma Kamanga ◽  
Nicholas Chikwenya ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Health Expenditure ◽  
Maternal Health Services ◽  
Health Facilities ◽  
District Level ◽  
Health Service Provision ◽  
Equity Of Access ◽  
The Impact

Abstract Zambia has been using output-based approaches for over two decades to finance whole or part of the public health system. Between 1996 and 2006, performance-based contracting (PBC) was implemented countrywide with the Central Board of Health (CBoH) as the provider of health services. This study reviews the association between PBC and equity of access to maternal health services in Zambia between 1996 and 2006. A comprehensive document review was undertaken to evaluate the implementation process, followed by a trend analysis of health expenditure at district level, and a segmented regression analysis of data on antenatal care (ANC) and deliveries at health facilities that was obtained from five demographic and health survey datasets (1992, 1996, 2002, 2007 and 2014). The results show that PBC was anchored by high-level political support, an overarching policy and legal framework, and collective planning and implementation with all key stakeholders. Decentralization of health service provision was also an enabling factor. ANC coverage increased in both the lower and upper wealth quintiles during the PBC era, followed by a declining trend after the PBC era in both quintiles. Further, the percentage of women delivering at health facilities increased during the PBC era, particularly in rural areas and among the poor. The positive trend continued after the PBC era with similar patterns in both lower and upper wealth quintiles. Despite these gains, per capita health expenditure at district level declined during the PBC era, with the situation worsening after the PBC era. The study concludes that a nationwide PBC approach can contribute to improved equity of access to maternal health services and that PBC is a cost-efficient and sustainable policy reform. The study calls for policymakers to comprehensively evaluate the impact of health system reforms before terminating them.

scholarly journals The impact of a multi-level maternal health programme on facility delivery and capacity for emergency obstetric care in Zambia

2017 ◽  
Vol 13 (10) ◽  
pp. 1481-1494 ◽  
Author(s):  
Elizabeth G. Henry ◽  
Donald M. Thea ◽  
Davidson H. Hamer ◽  
William DeJong ◽  
Kebby Musokotwane ◽  
...  
Keyword(s):  
Maternal Health ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Facility Delivery ◽  
Multi Level ◽  
The Impact ◽  
Health Programme

scholarly journals The Impact of Privatization of IDBI Bank in Indian Economy

2020 ◽  
Vol 3 (12) ◽  
pp. 59-63
Author(s):  
Vishal Kumar ◽  
Soumak Ganguly ◽  
Payal Ghosh ◽  
Manisha Pal
Keyword(s):  
Private Sector ◽  
Banking Sector ◽  
Financial Statement ◽  
Government Control ◽  
Public And Private ◽  
The Public ◽  
The Government ◽  
Public And Private Sector ◽  
The Impact ◽  
Share Value

Privatization refers to the public shares and Assets which are sold to the private sector in the economy. It decreases the power of government control and creates the other policies method. Privatization leads to cutting short the capital and revenue expenditure, which leads to an increase in share value in the market. During the pre-privatization period, the government used to pay less amounts of dividends to its shareholders due to its complex cost structure. Privatization leads to cutting short the capital and revenue expenditure, which leads to an increase in share value in the market. It also gave information about Public and Private sector banks. Our objective is to compare the pre and post-privatization performance like other banks of developing countries shows that privatization resulted in significant gains in profitability and efficiency. To evaluate the impact of privatization in the Indian banking sector and the relationship between privatization and Indian Economic growth by using a case study of IDBI bank condition of Indian private sector banks is analyzed using the financial statement of IDBI Bank with the help of different research methodologies.

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