Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya.

摘要: This study explores the relationship between two health financing initiatives on women's progression through maternal continuum in Kenya: a subsidized reproductive voucher programme (2006-16) and introduction of free maternity services all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining effects programme, policy, insurance other determinants (1) early antenatal care (ANC) initiation (first visit within first trimester pregnancy), (2) receiving continuous (1+ ANC, facility birth, 1+ post-natal (PNC) check) (3) completing pathway as recommended (4+ PNC, with check occurring 48 h delivery). Full implementation was positively associated among users ANC [interaction term adjusted odds ratio (aOR): 1.33, P = 0.014]. Early (aOR: 1.32, P = 0.001) use private sector 1.93, P < 0.001) were also users. Among users, increased 3.80, P < 0.001). Higher parity negatively outcomes, while having each outcome. The impact sociodemographic factors such age, education, wealth quintile, urban residence, employment varied by outcome; however, findings generally suggest that marginalized women faced greater barriers to continuity care. Health timing source are strongly related their subsequent pathway. To increase improve policymakers must therefore focus equitably reducing financial seeking improving quality throughout continuum.