In 2004, The Kenyan government removed user fees in public dispensaries and health centers and replaced them with registration charges of 10 and 20 Kenyan shillings (2004 $US 0.13 and $0.25), respectively. This was termed the 10/20 policy. We examined the effect of this policy on the coverage, timing, source, and content of antenatal care (ANC), and the equity in these outcomes. Data from the 2003, 2008/9 and 2014 Kenya Demographic and Health Surveys were pooled to investigate women’s ANC care-seeking. We conducted an interrupted time series analysis to assess the impact of the 10/20 policy on the levels of and trends in coverage for 4+ ANC contacts among all women; early ANC initiation and use of public facility-based care among 1+ ANC users; and use of public primary care facilities and receipt of good content, or quality, of ANC among users of public facilities. All analyses were conducted at the population level and separately for women with higher and lower household wealth. The policy had positive effects on use of 4+ ANC among both better-off and worse-off women. Among users of 1+ ANC, the 10/20 policy had positive effects on early ANC initiation at the population-level and among better-off women, but not among the worse-off. The policy was associated with reduced use of public facility-based ANC among better-off women. Among worse-off users of public facility-based ANC, the 10/20 policy was associated with reduced use of primary care facilities and increased content of ANC. This study highlights mixed findings on the impact of the 10/20 policy on ANC service-seeking and content of care. Given the reduced use of public facilities among the better-off and of primary care facilities among the worse-off, this research also brings into question the mechanisms through which the policy achieved any benefits and whether reducing user fees is sufficient for equitably increasing healthcare access.

中文翻译：

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研究肯尼亚1997-2012年公共初级保健设施中用户费用的减少：对产前保健的使用和内容的影响。

2004年，肯尼亚政府取消了公共药房和医疗中心的使用费，并分别以10肯尼亚先令和20肯尼亚先令的注册费（2004年为0.13美元和0.25美元）代替了它们。这被称为10/20政策。我们研究了这项政策对产前护理（ANC）的覆盖范围，时间，来源和内容的影响，以及这些结果的公平性。汇总了2003、2008 / 9和2014年肯尼亚人口与健康调查的数据，以调查妇女在ANC求医的情况。我们进行了中断的时间序列分析，以评估10/20政策对所有女性中4个以上ANC联络人的水平和覆盖趋势的影响；早于ANC发起并在1个以上ANC用户中使用基于公共设施的护理；公共初级保健设施的使用以及良好内容或质量的接收，公共设施使用者中ANC的数量。所有分析均在人口水平上进行，并分别针对家庭财富较高和较低的女性进行。该政策对富裕和较贫穷妇女中4+ ANC的使用产生了积极影响。在拥有1个以上ANC的用户中，10/20政策对人群一级和较富裕女性中的ANC早期启动产生了积极影响，但对较贫困的女性则没有影响。该政策与富裕妇女减少使用基于公共设施的ANC有关。在基于公共设施的ANC的贫困用户中，10/20政策与减少初级保健设施的使用和增加ANC的内容有关。这项研究突出了关于10/20政策对ANC寻求服务和护理内容的影响的混合结果。