Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua.

OBJECTIVE: To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction. DESIGN: A community-based quasi-experimental intervention study from 2000 to 2002. SETTING: Low-income areas of Managua. INTERVENTION: Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers. STUDY PARTICIPANTS: A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher). MAIN OUTCOME MEASURES: User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations. RESULTS: User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction. CONCLUSION: Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.