2005年-世界发展银行全球_Kenya___Reaching_the_Poor_through_the_Private_Sector_A_Network_Model_for_Expanding_Access_to_Reproductive_Health_Services_28页_395kb

Summary of "KENYA: REACHING THE POOR THROUGH THE PRIVATE SECTOR - A NETWORK MODEL FOR EXPANDING ACCESS TO REPRODUCTIVE HEALTH SERVICES"

Core Content

This document presents a study on the Kisumu Medical and Educational Trust (K-MET), a nonprofit organization in Kenya that works with private medical providers to expand access to reproductive health (RH) services, particularly for the poor. The study investigates whether K-MET's model of training and supporting private for-profit providers can effectively increase RH service access without exacerbating inequities.

Main Points

Objective

To assess whether the K-MET model, which uses a network of private providers to deliver RH services, benefits the poor and promotes equity in service access.

Context

• Kenya has a population of around 30.7 million, with 80% in rural areas.
• High maternal mortality is partly attributed to unsafe abortions.
• The private sector plays a significant role in Kenya’s healthcare, with about 48% of health care outlets outside the government structure.
• K-MET was established in 1995 to improve access to maternal and child health services, especially in rural areas where government services are limited.

Methodology

• A mixed-methods approach was used, including:
  • Client exit interviews with 295 clients of K-MET providers.
  • Interviews with nonmember providers at 50 sites.
  • Household surveys of 500 families in the surrounding areas.
• Socioeconomic status was determined using asset ownership and factor scores from the 1998 Kenya DHS.

Key Findings

Client Demographics

• Clients of K-MET providers are similar in socioeconomic status to both nonmember providers and the general community.
• In rural areas, K-MET clients are slightly poorer than the community.
• In urban areas, K-MET clients are slightly richer than the community.

Educational Attainment

• In rural areas, K-MET clients are less educated than the surrounding community.
• In urban areas, K-MET clients are more educated than the community.
• The client base of both K-MET and non-K-MET providers reflects the same communities, suggesting that the model does not disproportionately serve the wealthy.

Service Use

• 39% of K-MET clients reported using the services for reproductive health reasons.
• 32% of nonmember clients reported similar use.
• The difference is not statistically significant after adjusting for wealth, indicating that K-MET does not significantly alter access patterns based on income.

Equity Considerations

• The K-MET network does not exacerbate inequities in access to reproductive health services.
• The model is viable in rural areas, where government services are often inaccessible.
• It leverages existing private infrastructure, reducing costs and improving efficiency.

Key Information

• K-MET Network: Composed of approximately 180 private medical practices, with 65 exclusively private and 139 working part-time in the public or NGO sectors.
• Training and Support: K-MET provides free training, MVA kits, contraceptive supplies, and low-interest loans to its network providers.
• Provider Types: Includes nurses, clinical officers, and midwives, with a majority being nurses and clinical officers.
• Sample Size:
  • 295 exit interviews with K-MET clients.
  • 138 exit interviews with nonmember clients.
  • 500 household interviews.

Policy Implications

• The K-MET model promotes equitable access to reproductive health services, particularly in rural areas.
• It demonstrates that private sector involvement can be effective in reaching the poor when integrated with nonprofit support.
• The model can be replicated or expanded to improve access to affordable RH services for the poorest segments of the population.

Conclusion

The study concludes that the K-MET model successfully expands access to reproductive health services without increasing inequity. By training and supporting private providers, the network ensures that services are available in areas where government provision is limited, thereby improving access for the poor. This approach is particularly relevant in rural regions where public infrastructure is lacking and the private sector can play a critical role in service delivery.