Effectiveness of the Voucher Program on Modern Contraceptive Uptake among Adolescents in Kisii County, Kenya
Omari, Nyaiburi Alex
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The teenage pregnancy rate in Kenya is 18%, implying that 1 in every 5 teenage girls between the age of 15 to 19 years have begun childbearing (are pregnant with the first child or have had a live birth). The high teenage pregnancy and birth rates in Kisii County are due to the high unmet need for contraceptives in the County. A voucher program which is a demand-side financing mechanism enables clients with a voucher to access free services from accredited third-party voucher service providers. Vouchers have been hypothesized to address both informational and financial barriers. The study design that was applied was the cross-sectional study design that focused on program effects among those who accessed contraceptives services with vouchers and those who accessed services without voucher in the program clinics. A mixed methodology of quantitative and qualitative techniques was used whereby facility level data from the facilities that were purposively sampled was collected. A total of 423 respondents from Amua facilities in the study Sub County were randomly selected and their response rate was 91.7%. Two in-depth interviews, five key informant interviews and five focus group discussions were conducted. Descriptive data was analyzed by use of the Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel to analyze facility level data in the Ministry of Health (MOH) 512 tool by generating frequency tables, graphs, and piecharts. Inferential statistics was calculated using Chi-Square tests (p=0.005), at 95% confidence level and Fisher‟s Exact Test to determine the relationship between the variables. The proportion of adolescents vis-à-vis all clients in 8 services clinics before the voucher was 12% while during voucher period there was a significant increase (4 times increase) of the number adolescents‟ accessing services these clinics at 50%. There was a strong significant relationship between the perceptions of side effects and uptake of services (p=0.001). Peer support about contraception had minimal influence (p=0.038). There was a strong statistical association between the community level factors and uptake of contraceptives (p= 0.001). The Fisher‟s Exact Test also established a weak relationship between voucher use and the contraceptive method mix. (0.042). 73% of the voucher users took up Long Acting and Reversible Contraceptives (LARCs) and the uptake of Implants was the common contraceptive method at 49.12% while condoms were not utilized by voucher users at all because they were perceived not be contraceptive methods by the users. In conclusion, vouchers significantly affected the uptake of contraceptives and were effective in reaching the intended group (adolescents). Perceptions of side effects and community norms were the other major factors that affected uptake of contraceptives. With these findings, policy makers at the National and County level should expedite the process of providing medical insurance to all adolescents under EduAfya medical insurance in order to as to mitigate the cost barrier that is involved when adolescents seek contraceptive services. Currently, only the adolescents registered on National Education Management Information System (NEMIS) database in public secondary schools are covered by the EduAfya cover. In addition, the Kisii County government should prioritize community sensitization through the community dialogues to address the community norms that impede contraceptive access by adolescents.