Albert Kaonga - Academia.edu (original) (raw)
Papers by Albert Kaonga
The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO pro... more The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations 3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report 3ie accepted the final version of this report, The use of peer referral incentives to increase demand for voluntary medical male circumcision in Zambia, in November 2015 as partial fulfilment of requirements under grant TW3.16 issued under Thematic Window 3. The content has been copy edited and formatted for publication by 3ie. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its Board of Commissioners.
Journal of acquired immune deficiency syndromes (1999), Aug 15, 2016
Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV ep... more Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to underst...
Journal of acquired immune deficiency syndromes (1999), Jan 15, 2016
Zambia has high HIV prevalence and low voluntary medical male circumcision (VMMC) rates, heighten... more Zambia has high HIV prevalence and low voluntary medical male circumcision (VMMC) rates, heightening the need for effective VMMC demand generation strategies for HIV prevention. A 3-arm randomized controlled trial measured the impact of 2 short message service (SMS) campaigns on self-reported and verified VMMC uptake over 6 months in Lusaka Province. The study enrolled 2312 uncircumcised males aged 15-30 previously subscribed on Zambia U-Report, an existing SMS platform providing confidential, free counseling services relevant to HIV and other sexually transmitted infections. Participants in the "Conventional" campaign group received a standard package of messages promoting VMMC. Messages sent to the "Tailored" campaign group were targeted at participants' intention level to get circumcised. The control group had routine counselor access through SMS. Data were collected using SMS surveys, and verification of self-reported VMMC uptake used health facility clie...
2014 surveys, respectively. For this study, births were converted to percentages of facility-base... more 2014 surveys, respectively. For this study, births were converted to percentages of facility-based deliveries amongst all deliveries, as Kenya DHS used a different sample size in 2014. Analysis shows steady national increase in facility delivery proportions over time (40% in 2003 to 61% in 2014), consistent in urban and rural areas, although urban facility deliveries were substantially greater. This pattern is reflected in public facility delivery trends, yet there is no consistent pattern for private facilities. Facility deliveries were greater amongst richer women, although the increase over time was consistent amongst all subgroups. This report's second component is a voucher study, with pairs of difference-indifferences tests of three rounds of cross-sectional household surveys determining whether exposure to a vouchers programme is associated with changes in facility-based deliveries for each survey round. Three rounds of data collection (2010, 2012 and 2016) recorded 4,804 births, predominantly amongst rural, married mothers who were multiparous, with primary educations or less, unemployed or informally employed, and uninsured, across intervention groups and time. Women in both voucher and comparison sites reported four or more antenatal care visits for 60-65 per cent of births in periods 1 and 2. After free maternity services, this increased moderately, with a greater proportion in voucher sites receiving four or more antenatal care visits (72% versus 66%). In both groups, health facility deliveries increased from about half of all births in period 1 to approximately 85 per cent in period 3. Although there was no difference in access to facility deliveries in periods 1 and 3, a greater proportion of births in period 2 were at facilities in voucher sites (69% versus 59%). Early attempts to introduce user fees to support facilities' operational costs did not produce intended positive effects on maternal healthcare use. Those early policies introduced distortions in service provision that were not fully addressed in subsequent user fee policies. Without adequate alternative revenue sources for facilities, improving access to critical services is difficult. Promising strategic purchasing models, such as health vouchers and social health insurance, suggest that directing payments to facilities for services based on consumer demand and utilisation can produce intended effects in improving access to health services for underserved populations.
The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO pro... more The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie impact evaluations 3ie-supported impact evaluations assess the difference a development intervention has made to social and economic outcomes. 3ie is committed to funding rigorous evaluations that include a theory-based design, use the most appropriate mix of methods to capture outcomes and are useful in complex development contexts. About this report 3ie accepted the final version of this report, The use of peer referral incentives to increase demand for voluntary medical male circumcision in Zambia, in November 2015 as partial fulfilment of requirements under grant TW3.16 issued under Thematic Window 3. The content has been copy edited and formatted for publication by 3ie. All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its Board of Commissioners.
Journal of acquired immune deficiency syndromes (1999), Aug 15, 2016
Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV ep... more Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to underst...
Journal of acquired immune deficiency syndromes (1999), Jan 15, 2016
Zambia has high HIV prevalence and low voluntary medical male circumcision (VMMC) rates, heighten... more Zambia has high HIV prevalence and low voluntary medical male circumcision (VMMC) rates, heightening the need for effective VMMC demand generation strategies for HIV prevention. A 3-arm randomized controlled trial measured the impact of 2 short message service (SMS) campaigns on self-reported and verified VMMC uptake over 6 months in Lusaka Province. The study enrolled 2312 uncircumcised males aged 15-30 previously subscribed on Zambia U-Report, an existing SMS platform providing confidential, free counseling services relevant to HIV and other sexually transmitted infections. Participants in the "Conventional" campaign group received a standard package of messages promoting VMMC. Messages sent to the "Tailored" campaign group were targeted at participants' intention level to get circumcised. The control group had routine counselor access through SMS. Data were collected using SMS surveys, and verification of self-reported VMMC uptake used health facility clie...
2014 surveys, respectively. For this study, births were converted to percentages of facility-base... more 2014 surveys, respectively. For this study, births were converted to percentages of facility-based deliveries amongst all deliveries, as Kenya DHS used a different sample size in 2014. Analysis shows steady national increase in facility delivery proportions over time (40% in 2003 to 61% in 2014), consistent in urban and rural areas, although urban facility deliveries were substantially greater. This pattern is reflected in public facility delivery trends, yet there is no consistent pattern for private facilities. Facility deliveries were greater amongst richer women, although the increase over time was consistent amongst all subgroups. This report's second component is a voucher study, with pairs of difference-indifferences tests of three rounds of cross-sectional household surveys determining whether exposure to a vouchers programme is associated with changes in facility-based deliveries for each survey round. Three rounds of data collection (2010, 2012 and 2016) recorded 4,804 births, predominantly amongst rural, married mothers who were multiparous, with primary educations or less, unemployed or informally employed, and uninsured, across intervention groups and time. Women in both voucher and comparison sites reported four or more antenatal care visits for 60-65 per cent of births in periods 1 and 2. After free maternity services, this increased moderately, with a greater proportion in voucher sites receiving four or more antenatal care visits (72% versus 66%). In both groups, health facility deliveries increased from about half of all births in period 1 to approximately 85 per cent in period 3. Although there was no difference in access to facility deliveries in periods 1 and 3, a greater proportion of births in period 2 were at facilities in voucher sites (69% versus 59%). Early attempts to introduce user fees to support facilities' operational costs did not produce intended positive effects on maternal healthcare use. Those early policies introduced distortions in service provision that were not fully addressed in subsequent user fee policies. Without adequate alternative revenue sources for facilities, improving access to critical services is difficult. Promising strategic purchasing models, such as health vouchers and social health insurance, suggest that directing payments to facilities for services based on consumer demand and utilisation can produce intended effects in improving access to health services for underserved populations.