背景:COVID-19大流行导致非接触式支付和政府现金转移计划的数字金融服务空前普及,以减轻大流行的经济影响。大流行对低收入和中等收入国家使用数字金融服务促进健康的影响,然而,知之甚少。
目的:本研究旨在评估首次COVID-19封锁对使用移动孕产妇健康钱包的影响,特别侧重于描述年龄相关的差异效应,并就封锁措施对数字医疗服务使用的影响得出结论。
方法:我们分析了来自塔那那利佛25家公共部门初级保健机构和4家医院的3416名女性的819,840人日健康钱包使用数据,马达加斯加,2020年1月1日至8月27日。我们收集了储蓄数据,付款,和凭证在护理点使用。为了评估马达加斯加首次COVID-19封锁的影响,我们在2020年3月23日首次COVID-19封锁开始日前后使用了回归不连续性分析。我们使用数据驱动方法确定带宽,用于无偏带宽选择,并使用改进的泊松回归用于二元变量,以估计锁定效应大小的风险比。
结果:我们记录了3719个保存事件,1572个付款事件,和3144使用事件的电子凭证。马达加斯加的首次COVID-19封锁将移动货币节省减少了58.5%(P<.001),付款量为45.8%(P<.001),凭证使用率下降49.6%(P<.001)。214天后,凭单使用恢复到推断的锁定前反事实,而储蓄和付款并没有超过推断的封锁前的反事实。封锁后的恢复时间因年龄组而异。年龄>30岁的妇女恢复得更快,在34、226和77天后恢复到提前封锁率,以节省资金,付款,和优惠券使用,分别。年龄<25岁的年轻女性没有恢复到基线值。在使用±20天的最佳带宽的灵敏度分析中,结果保持稳健。
结论:COVID-19的封锁大大减少了移动货币在卫生部门的使用,影响储蓄,付款,和代金券使用。储蓄减少的幅度最大,这意味着封锁影响了女性对未来医疗保健使用的期望。付款和代金券使用的下降表明,封锁导致实际医疗保健使用减少。这些影响至关重要,因为许多妇幼保健服务不能延迟,因为潜在的利益将丢失或减少。为了减轻封锁对孕产妇保健服务使用的不利影响,可以利用数字医疗服务来提供远程医疗服务,并通过有关可用医疗服务访问选项和遵守安全协议的明确信息来增强用户通信。
BACKGROUND: The COVID-19 pandemic resulted in the unprecedented popularity of digital financial services for contactless payments and government cash transfer programs to mitigate the economic effects of the pandemic. The effect of the pandemic on the use of digital financial services for health in low- and middle-income countries, however, is poorly understood.
OBJECTIVE: This study aimed to assess the effect of the first COVID-19 lockdown on the use of a mobile maternal health wallet, with a particular focus on delineating the age-dependent differential effects, and draw conclusions on the effect of lockdown measures on the use of digital health services.
METHODS: We analyzed 819,840 person-days of health wallet use data from 3416 women who used health care at 25 public sector primary care facilities and 4 hospitals in Antananarivo, Madagascar, between January 1 and August 27, 2020. We collected data on savings, payments, and voucher use at the point of care. To estimate the effects of the first COVID-19 lockdown in Madagascar, we used regression discontinuity analysis around the starting day of the first COVID-19 lockdown on March 23, 2020. We determined the bandwidth using a data-driven method for unbiased bandwidth selection and used modified Poisson regression for binary variables to estimate risk ratios as lockdown effect sizes.
RESULTS: We recorded 3719 saving events, 1572 payment events, and 3144 use events of electronic vouchers. The first COVID-19 lockdown in Madagascar reduced mobile money savings by 58.5% (P<.001), payments by 45.8% (P<.001), and voucher use by 49.6% (P<.001). Voucher use recovered to the extrapolated prelockdown counterfactual after 214 days, while savings and payments did not cross the extrapolated prelockdown counterfactual. The recovery duration after the lockdown differed by age group. Women aged >30 years recovered substantially faster, returning to prelockdown rates after 34, 226, and 77 days for savings, payments, and voucher use, respectively. Younger women aged <25 years did not return to baseline values. The results remained robust in sensitivity analyses using ±20 days of the optimal bandwidth.
CONCLUSIONS: The COVID-19 lockdown greatly reduced the use of mobile money in the health sector, affecting savings, payments, and voucher use. Savings were the most significantly reduced, implying that the lockdown affected women\'s expectations of future health care use. Declines in payments and voucher use indicated decreased actual health care use caused by the lockdown. These effects are crucial since many maternal and child health care services cannot be delayed, as the potential benefits will be lost or diminished. To mitigate the adverse impacts of lockdowns on maternal health service use, digital health services could be leveraged to provide access to telemedicine and enhance user communication with clear information on available health care access options and adherence to safety protocols.