Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua

Meuwissen, Liesbeth E.; Gorter, Anna C.; Kester, Arnold D. M.; Knottnerus, J. Andre
January 2006
BMC Public Health;2006, Vol. 6, p204
Academic Journal
Background: Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP) method for such evaluation. Methods: 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher) and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after). Also the influence of doctors' characteristics was tested using non-parametric statistical methods. Results: Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01). Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02). Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. Conclusion: This study illustrates provider-related obstacles adolescents often face when requesting contraception. The care provided during the voucher program improved for some important outcomes. The improvements were more pronounced among providers with the weakest initial performance. Shared decision-making and condom promotion were improvements that sustained after the program ended. The SP method is suitable and relatively easy to apply in monitoring clinics' performance, yielding important and relevant information. Objective assessment of change through the SP method is much more complex and expensive.


Related Articles

  • Setting Research Priorities for Adolescent Sexual and Reproductive Health.  // Contemporary Sexuality;Mar2013, Vol. 47 Issue 2, p9 

    The article discusses adolescent sexual and reproductive health, with a focus on a study by researchers at the Johns Hopkins Bloomberg School of Public Health to identify research priorities for adolescents in low- and middle-income countries.

  • Transparent criteria for specialist level adolescent psychiatric care. Kaltiala-Heino, Riitakerttu; Fröjd, Sari; Laukkanen, Eila; Närhi, Pekka; Rantanen, Päivi // European Child & Adolescent Psychiatry;Jun2007, Vol. 16 Issue 4, p260 

    Rising health care costs and long waiting lists pose a challenge to public specialist level health services. In Finland, the Ministry of Social Affairs and Health required all medical specialities to create a priority-rating tool for elective patients, preferably giving a numerical rating...

  • Economic Burden of Polycystic Ovary Syndrome During Reproductive Life Span.  // Fertility Weekly;10/17/2005, p8 

    The article states that according to researchers in the U.S., total annual cost of evaluating and treating American women with polycystic ovary syndrome (PCOS) during their childbearing years comes to $4.36 billion. Approximately one in fifteen unselected women in the U.S. has PCOS. This...

  • Questioning the assumptions in the debate on assisted reproduction: comment on the House of Commons report Human Reproductive Technologies and the Law. Pennings, Guido // Reproductive BioMedicine Online (Reproductive Healthcare Limited;Aug2005, Vol. 11 Issue 2, p152 

    The House of Commons Science and Technology Committee has issued a series of non-dogmatic recommendations. Also regarding elective sex selection, it has adopted a controversial position. Sex selection should be allowed for family balancing. However, the acceptability of preimplantation genetic...

  • Sickle Cell Hospital Unit: Practitioner Application.  // Journal of Healthcare Management;Sep/Oct2008, Vol. 53 Issue 5, p316 

    The article discusses another article in the issue, examining an inpatient model used to manage adult patients who have acute and chronic sickle cell disease (SCD) in urban hospitals. A direct call-in triage system allows the patients to bypass the emergency department, the author states. Topics...

  • How much does it cost to treat teens with anorexia nervosa in hospital?  // CMAJ: Canadian Medical Association Journal;6/16/2015, Vol. 187 Issue 9, p658 

    The article discusses research about health and medical care. Topics discussed include the calculation of the costs of treating teenagers with anorexia nervosa at a tertiary care hospital in Canada, including hospital cost, caregiver cost and societal cost, and the preparedness of tertiary care...

  • Youth SRHR in the Pacific: Deserving Urgent Attention. Spratt, Joanna // ARROWs for Change;Sep2009, Vol. 15 Issue 2/3, p20 

    The article discusses the progress made in addressing the needs of sexual and reproductive health (SRH) services for youths in Pacific Island. It states that legislation supporting and protecting women's right have been issued in some countries and access to antennal care has also improved. It...

  • Information and Communications Technology in Sexual and reproductive health care for Adolescents. Pozo, Kathya Cordova; Hagens, Arnold J. J. // Annual Global Healthcare Conference;2013, p112 

    In Bolivia, health care service is not widely used, particularly preventive and primary health care. Health service is often expensive and in some cases, becomes a source of inequality. A big part of the health problems during adolescence is related to sexual and reproductive health. This...

  • Client and Provider Perspectives on Adolescent Reproductive and Sexual Health Services in India.  // Population Briefs;Dec2014, Vol. 20 Issue 3, p6 

    The article offers information on the adolescent reproductive and sexual health services in India. Topics discussed include the adolescents' and health care providers' perspective on the services in the country, and recommendations for improving health services. The article mentions that a very...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics