Huntington et al Health Research Policy and Systems Page 4 of 8

Huntington et al health research policy and systems

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Huntington et al. Health Research Policy and Systems 2012, 10 :25 Page 4 of 8
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Table 2 Longitudinal Model Results for 4 categories of health service monthly case load by cohort Variable Birth Spacing Methods Maternal Health Services Child Health Services Other Health Services Cohort 2007 v.s. Cohort 2005 Cohort 2009 v.s. Cohort 2007 Cohort 2007 v.s. Cohort 2005 Cohort 2009 v.s. Cohort 2007 Cohort 2007 v.s. Cohort 2005 Cohort 2009 v.s. Cohort 2007 Cohort 2007 v.s. Cohort 2005 Cohort 2009 v.s. Cohort 2007 Cohort - 45.22** - 33.00** - 39 16 - 49*** - 27** - 3 3 ( - 87.09 - -3.36) ( - 61.62 - -4.38) ( - 112.22 - 34.32) ( - 19.77 - 51.71) ( - 81.98 - -15.18) ( - 51.24 - -2.30) ( - 8.45 - 2.56) ( - 5.02 - 10.58) Gender(reference: Male) 85.90*** 37.02** - 19 - 24 78*** 34*** 5 3 (40.30 - 131.51) (7.83 - 66.20) ( - 98.69 - 60.94) ( - 60.51 - 12.39) (41.51 - 114.29) (8.75 - 58.67) ( - 1.17 - 10.83) ( - 5.33 - 10.58) Age at Joining Franchise - 3.77** - 0.45 - 6** - 1 - 4*** - 1 - 0 0 ( - 6.86 - -0.68) ( - 1.81 - 0.90) ( - 10.95 - -0.15) ( - 3.05 - 0.35) ( - 6.28 - -1.36) ( - 1.82 - 0.50) ( - 0.61 - 0.21) ( - 0.30 - 0.44) Constant 314.39*** 112.44*** 442*** 189*** 317*** 120*** 27*** 11 (159.26 - 469.53) (38.16 - 186.71) (170.99 - 713.99) (96.54 - 282.05) (193.72 - 441.27) (56.00 - 183.03) (6.97 - 47.78) ( - 9.36 - 31.13) Observations 3,048 3,648 3,048 3,648 3,048 3,648 3,048 3,648 Number of Providers 127 152 127 152 127 152 127 152 Note: 95% confidence intervals in brackets, *** p<0.01, ** p<0.05, * p<0.1. Huntington et al. Health Research Policy and Systems 2012, 10 :25 Page 5 of 8
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consultations during the 24 months of data collection. The effects of joining the franchise on family planning services is clearly shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician over the 24 month study period, (p <0.01). The increase during the first 24 months of membership in the franchise appears to be sustained during the second 24 month period as well, as shown in the finding that the 2007 cohort reported a significant increase of monthly average service volume from 71.2 per physician to 102.8 per physician (p<0.01). These effects appear to be diminished during the third 24 month period of franchise membership, as the 2005 cohort reported no significant change in family planning service volume. This pattern shows the accumulative positive impact of joining the social franchise on the medical service volume and income of providers. The Ministry of Health in Myanmar reported no increase in the use of family planning between 2009 2011 in the states where the cohort study was conducted,[17], al- though this data is at a high level of aggregation and is of limited value in making direct comparisons to the study sites. Prior to the study period the national fertility and reproductive health survey reported an increase in contraceptive prevalence. If that was the beginning of a trend it could suggest that the SQH providers in our study were benefiting by an overall increase in family planning use in the country. Our longitudinal results of changes in medical ser- vices, summarized in Table 2, indicate that the longer the provider remains in the franchise, the greater likeli- hood that there will be increases in the case load of child health services (significant differences), and modest (al- though not statistically significant) increases in maternal and other types of service case loads. During the 24- month period when the data were reported, the average monthly volume of family planning services of cohort 2005 is 45.22 more than that of cohort 2007, and differ- ence is statistically significant (p <0.05). Cohort 2007 also had a larger monthly volume of family planning ser- vices than cohort 2009 did. The same pattern is observed for child health services. Cohorts who joined
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