Effectiveness of the Voucher Program on Modern Contraceptive Uptake among Adolescents in Kisii County, Kenya
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Date
2021
Authors
Omari, Nyaiburi Alex
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
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.
Description
A Research Thesis Submitted in Partial Fulfillment of the Requirements for the Award of the Degree of Master of Public Health (Reproductive Health) in the School of Public Health and Applied Human Sciences at Kenyatta University, October 2021
Keywords
Effectiveness, Voucher Program, Modern Contraceptive Uptake, Adolescents, Kisii County, Kenya