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Objective: This study evaluates how a subsidized, mobile phone-based health insurance program affected insurance uptake, healthcare utilization and health expenditures for low-income women and their family members in Western Kenya. The program, targeting pregnant women and mothers of children below age four, addressed both demand- and supply-side c...
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... subgroup estimates based on the heterogeneity analyses are reported in Panel a) of the Appendix Tables A1-A7. We do not find a statistically significant difference in enrolment rates between adults and children (Table A1) nor between male and female adults (Table A2) or between boys and girls (Tables A3-A4). Table A5 indicates that individuals in poor households (of below-median wealth) were less likely to be insured than individuals in non-poor households at baseline (11.2 vs 28.0 percent, respectively). ...Context 2
... example, while male adults reported less health problems pre-intervention than female adults (7.8 versus 11.0 percent of weeks), the program did not differentially affect their health (Appendix Table A2). Boys and girls both of young and schoolage report highly similar rates of illnesses and injuries pre-and post-intervention (Tables A3 and A4). Noteworthy is that individuals linked to the private program facility started off with less health issues at baseline compared to the public facility (in 8.9 vs. 10.1 percent of weeks), and they were more likely to be affected by the program roll-out with a significant increase in reported ...Context 3
... differences among children are less pronounced (Tables A3-A4). School-aged boys (5-18 years) in treatment communities are more likely to consult a healthcare provider as a result of the program, but this concerns mostly informal care, while informal care for girls decreasesespecially for girls below 5. ...Context 4
... shown in the Appendix Tables, impact on financial coverage of general healthcare utilization is significantly larger for adult women than adult men: Whereas treated women see an increase in partially or fully covered costs of 26.8 percentage points, the impact for men is not discernable from zero (Table A2). The differential impact on school-aged girls versus boys is even larger at 45.2 and 11.2 percentages points, respectively (Table A3). This might be related to the greater need for healthcare among adolescent girls who enter their reproductive years. ...Context 5
... differential drop in OOPs is not linked to travel distance, but rather seems driven by a greater likelihood of individuals to use their new NHIF card at the private facility. Table 3 translates the individual OOPs into monthly household-level OOPs and compares them to households' monthly capacity to pay (CTP) to estimate the likelihood of catastrophic health expenditures (CHE). As shown, the average weekly OOPs aggregated to the household-month level significantly decreased due to the program. ...Citations
Over the past few decades, the world has witnessed considerable progress in women’s, children’s and adolescents’ health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs). This scoping review was conducted following Joanna Briggs Institute (JBI) guidance for conducting such reviews as well as the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for reporting scoping reviews. We searched Medline, PubMed, EMBASE and the World Health Organization’s (WHO) Global Index Medicus, and relevant websites. The selection process was conducted in duplicate and independently. Out of 26 355 citations identified from electronic databases, relevant website searches and stakeholders’ consultations, 413 studies were included in the final review. Conditional cash transfers (CCTs) (22.3%), health insurance (21.4%), user fee exemptions (18.1%) and vouchers (16.9%) were the most reported financial interventions and measures. The majority were targeted at women (57%) and children (21%) with others targeting adolescents (2.7%) and newborns (0.7%). The findings highlighted that CCTs, voucher programs and various insurance schemes can improve the utilization of maternal and child health services for the poor and the disadvantaged, and improve mortality and morbidity rates. However, multiple implementation challenges impact the effectiveness of these programmes. Some studies suggested that financial interventions alone would not be sufficient to achieve equity in health coverage among those of a lower income and those residing in remote regions. This review provides evidence on financing interventions to address the health needs of the most vulnerable communities. It can be used to inform the design of equitable health financing policies and health system reform efforts that are essential to moving towards universal health coverage (UHC). By also unveiling the knowledge gaps, it can be used to inform future research on financing interventions and measures to improve equity when addressing WCAH in LMICs.
