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Evaluating program effects on institutional delivery in Peru.
Michael J McQuestion1, Anibal Velasquez
1Johns Hopkins Bloomberg School of Public Health, Population and Family Health Sciences, 615 N Wolfe Street, E-4142, Baltimore, MD 21205, USA. mmcquest@jhsph.edu
Health Policy (Amsterdam, Netherlands)
|August 18, 2005
Summary
Peru's national maternal and child health insurance (SMI Program) increased public EmOC facility use. However, Proyecto 2000, aimed at improving EmOC quality, did not significantly impact delivery location choices. The programs' effects were independent.
Area of Science:
- Public Health
- Health Services Research
- Maternal Health
Background:
- Peru implemented two key health programs: the national maternal and child health insurance (SMI Program) for the poorest households and Proyecto 2000 to enhance emergency obstetric care (EmOC) quality and utilization in high-mortality areas.
- Understanding the independent and joint effects of these interventions on facility delivery choices is crucial for optimizing maternal healthcare strategies.
Purpose of the Study:
- To evaluate the combined impact of the SMI Program and Proyecto 2000 on women's decisions to deliver in public emergency obstetric care (EmOC) facilities in Peru.
- To assess the influence of improved EmOC quality and insurance coverage on maternal healthcare utilization.
Main Methods:
- Utilized data from the Proyecto 2000 endline evaluation, surveying 5335 mothers near 29 treatment and 29 matched control EmOC facilities.
- Employed propensity scoring and quality of care indices to analyze the impact of Proyecto 2000.
- Applied variance components logistic models to determine the effect of SMI Program enrollment and Proyecto 2000 treatment area residence on delivery location choice.
Main Results:
- Proyecto 2000 treatment facilities demonstrated significantly higher quality of care.
- Mothers enrolled in the SMI Program were more likely to deliver in public EmOC facilities, independent of household constraints.
- Residence in a Proyecto 2000 treatment area did not significantly influence the choice of delivery facility.
Conclusions:
- The SMI Program effectively increased the utilization of public EmOC facilities among eligible populations.
- While Proyecto 2000 improved EmOC quality, it did not significantly alter mothers' decisions regarding delivery location.
- The independent effects of the SMI Program and Proyecto 2000 suggest distinct mechanisms of influence on maternal healthcare choices.