WUNRN
Population Council - http://www.rhvouchers.org/
REPRODUCTIVE HEALTH VOUCHERS SAVE
LIVES OF POOR MOTHERS & BABIES
·
Give patients the economic power to demand
high-quality health care
·
Target high-risk or low-income patients for
critical services
·
Augment general population utilization
rates and contain per-unit costs
·
Offer incentives to service providers to
encourage innovation, cost-effectiveness, and responsiveness to clients
Components
A voucher is a
subsidized card that entitles a pregnant woman to antenatal visits, assisted
baby delivery including any complications, and a postnatal visit at her choice
of qualified facility.
A recipient (or client) is a poor, pregnant mother. A questionnaire called a
poverty grading tool is administered to each potential client to determine
eligibility for the voucher.
A service provider is a qualified health care facility contracted to
provide maternal health services to voucher recipients.
A claim is a
request for financial reimbursement for maternal health services provided to
voucher recipients.
A voucher management agency is a government, non government, or private-sector
organization charged with managing the financial and administrative tasks needed
to run voucher programs.
A community-based distributor is a person or organization charged with distributing
vouchers to eligible women in target communities.
A poverty grading tool is a questionnaire designed to assess the poverty status
of a potential voucher recipient.
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MOBILE PHONES & REPRODUCTIVE HEALTH VOUCHERS SAVE
LIVES OF MOTHER & BABIES
ByBen Bellows and Jared Stamm of the Population Council.
Mobile phone use in Africa is growing fast, from 16
million handsets in use in 2000 to 246 million in 2008 and more than 500
million by early 2013. In Kenya, 78% of households have mobile phones. In spite
of these high numbers, there is still concern that mobile interventions are failing
to reach the most in need. We believe this will become less of an issue as
mobile phone use continues to rise.
The Population Council’s voucher survey data reflect a
growing uptake of phones in poor households, and a substantial increase in the
use of mobile phones between 2010 and 2012 among the voucher-eligible
population (you can learn more about our study here and initial findings
here). And according to another recent
study in Kenya among people who have a mobile phone and make less than $2.50
per day, there is high demand for telecom services—low-income consumers
will forgo spending on some necessities in order to buy airtime—and growing
interest in receiving health information via mobile devices.
That’s good news for programs like Baby Monitor,
a screening tool being tested by the Population Council and Duke University
among pregnant women and new mothers in rural and remote areas of Kenya—places
where a mobile signal is more likely to reach them than a skilled birth attendant
or community health worker.
Baby Monitor brings low-cost clinical assessment directly
to mothers and their infants through their mobile phones. With Baby Monitor,
women sign up to get phone calls 90, 60, and 30 days before their due date, and
on days 1, 3, 7, and 10 after birth—the most critical days for a new baby and a
new mother.
Using interactive voice-response (IVR) technology, women
listen to a free phone call and respond by key press to a series of
pre-recorded, algorithm-selected questions that screen for potential physical
and mental health issues. The cloud-based, highly scalable program
automatically flags cases that warrant additional follow-up and then sends
information, makes referrals, and/or dispatches community health workers.
Early analyses of Baby Monitor indicate that it’s better
than nurses at detecting higher probable levels of depression, possibly because
women feel less stigma answering recorded questions by phone.
Programs like these hold a lot of promise for the poorest
women in the poorest communities. Next stages could be coordinating transport
to facility referrals; sharing screening data with receiving facilities to
speed intake; beginning the process of providing informed choice for preventive
care like family planning methods; helping patients adhere to treatment for HIV
or tuberculosis; and, in the case of reproductive
health vouchers, distributing credits by mobile phone that could pay for
health care or transport services.
With mobile phone penetration increasing in developing
countries and among the poorest, we have an opportunity to create lasting
change in the way valuable health services are delivered. Programs like Baby
Monitor may provide the blueprint for developing additional effective mhealth
programs or improving current programs like the reproductive health voucher
program in Kenya.
Harnessing the power of mobile phones to improve health
will be a challenge, but with strategic investment, collaboration between
public health researchers and technology developers, and a focus on creating
mhealth applications that are easy to use and available to the most vulnerable,
we can make great strides in improving health and saving lives.