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Table 2 Why might vitamin voucher take-up be more in the universal area? llustrative quotations of themes

From: An exploration of the statutory Healthy Start vitamin supplementation scheme in North West England

Mothers (Targeted): Accessibility and Adequacy of supply

“I try [to use the vitamin vouchers], if you can get them for free, you’ve seen I’ve got the voucher right here… but… I don’t know whether it’s because of the cutbacks or whether they’ve just stopped sending them, but the [children’s] centres where I go [to] ask for them—they just never have them.” EM26-T

“There was nowhere really to get them. Every time I’d ask in the doctors’ they said, ‘see your midwife’, and the midwife told me to look on the internet, but I haven’t got any internet at home… I have never ever got the vitamins because I don’t know where to get them from or anything…” EM27-T

Health professionals (Universal): Awareness and Accessibility

“…available in every children’s centre so that’s… six… within a radius of about ten miles? So they’re quite freely available […] from the receptionist…” HP05-U.

“Now locally […] [mothers are] given a form to come and get vitamins… from the children’s centre… […] Often I will give one of those forms to everybody because it means they can go and get them straight away because Healthy Start when you apply [takes ages] to come through.” HP04-U

Commissioner (Universal): Accessibility and Adequacy of supply

When the universal area had been a targeted area:

“The clinic staff [receptionists] outside here, because they were very rarely asked for [the vitamins], or would forget [to ask mothers for the voucher], and they would go out of date… And managers would just stop stocking them… they’d just fall off the agenda.” C03-U

Overclaiming did not explain higher vitamin take-up. Reimbursement claims related only to entitled mothers: “We keep a spreadsheet …from each children’s centre… mark E for eligible or L for local…” C03-U

[Mothers could only use either the locally produced or national voucher.]

Commissioner (Targeted): Attention (prioritizing)

Key stakeholders paid insufficient attention to improving vitamin take-up. A working group lacked midwife and GP engagement and “we failed miserably” C01-T to engage an accountant to help file HSIU returns. That commissioner also wanted more active listening from: “[the Department of Health] …get people from different parts of the country, sit down and talk to them and say, OK, what, what are our barriers?” C01-T

  1. From interviews in 2012 with potentially eligible mothers, health professionals, and commissioners about Healthy Start (in a universal and a targeted area in North West England)
  2. EM = entitled mother; HP = health professional; C = commissioner; universal = U, targeted = T
  3. HSIU = Healthy Start Issuing Unit