Universal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior, and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake. This is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach—including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments—in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya. People in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels—individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based “health wallet,” it enhances enrolment in subsidized health insurance through the mobile platform—M-TIBA—developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool—AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. Registered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571 : AEARCTR-0006089 ; date: 29 August 2019) and The American Economic Association’s registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020).

中文翻译：

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i-PUSH 对母婴保健利用、健康结果和财务保护的影响：基于财务和健康日记数据的集群随机对照试验的研究方案

全民健康覆盖确保所有人都能获得优质的卫生服务，在获得所需服务时没有经济困难。然而，在包括肯尼亚在内的低收入和中等收入国家，大量资源短缺造成了服务提供差距，从而损害了获得优质卫生服务的机会。由 AMREF Health Africa 和 PharmAccess Foundation (PAF) 开发的普遍可持续医疗创新伙伴关系 (i-PUSH) 计划旨在通过创新的数字工具增强低收入育龄妇女及其家庭的能力。本研究旨在评估 i-PUSH 对母婴保健利用、妇女健康（包括她们的知识、行为和接受相应服务）以及妇女赋权和财务保护的影响。它还旨在评估 LEAP 培训工具对增强社区健康志愿者的健康素养的影响，并评估 M-TIBA 健康钱包对健康和健康保险储蓄储蓄的影响。这是一项集群随机对照试验 (RCT) 研究的研究方案，该研究使用四管齐下的方法——包括为期一年的每周财务和健康日记访谈、基线和终点调查、定性研究和行为实验室-实地试验——在肯尼亚卡克梅加县。随着时间的推移，来自卡卡梅加 24 个村庄的 240 户家庭将被跟踪，以了解他们的健康状况、健康知识、求医行为、健康支出和健康保险的加入情况。一半的家庭居住在随机分配到基线后将实施 i-PUSH 的处理组的村庄，而另一半家庭居住在控制村，直到结束后才实施 i-PUSH。研究方案由 AMREF 伦理和科学审查委员会审查和批准。研究许可是从肯尼亚国家科学、技术和创新委员会获得的。低收入和中等收入国家的人们经常自付高额的医疗保健支出，这反过来又阻碍了他们获得优质医疗服务。为医疗保健储蓄以及加入医疗保险可以通过在各个层面（个人、家庭和社区）建设能力来改善获得医疗保健的机会。尤其，i-PUSH通过基于手机的“健康钱包”促进医疗保健储蓄，通过PAF开发的移动平台M-TIBA增加补贴健康保险的注册，并寻求通过社区提高健康知识和行为使用 LEAP 工具（AMREF 的 mHealth 平台）进行培训的健康志愿者 (CHV)。调查结果将告知利益相关者制定更好的战略，以确保总体上获得全民健康覆盖，特别是人口中高度脆弱的部分，包括低收入母亲及其子女。在方案注册和结果系统（方案 ID：AfricanPHRC；试验 ID：NCT04068571：AEARCTR-0006089；日期：2019 年 8 月 29 日）和美国经济学会随机对照试验注册处（试验 ID：AEARCTR-0006089；