Community-level effect of the maternal health voucher program on out-of-pocket spending on delivery services at private health facilities in Uganda

This paper examines the community-level effect of the maternal health voucher program on out-of-pocket spending on delivery services at private health facilities in Uganda. Household-level data were collected before (in 2008) and two years after the program started (in 2010-2011) among women aged 15-49 years who had a birth in the 12 months preceding the survey. A total of 1,569 women were interviewed in 2008 with 327 most recent births occurring at a private health facility; the corresponding figures for 2010-2011 were 666 women with 196 most recent births occurring at a private health facility. The effect of the program is determined by difference-in-differences estimation through simple comparison of changes in proportions as well as the estimation of a multilevel random-intercept logit model. The results show that there was a significantly greater decline in the proportion of women that paid for delivery services and in the likelihood of paying for the services at private facilities in exposed than in non-exposed villages. The findings indicate that the maternal health voucher program significantly contributed to reductions in the likelihood of paying out-of-pocket for delivery services at private health facilities in the regions where it is implemented.