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Presentation

Session: Maternal Health
Room: Main Hall
Time: Thu 14:30-15:45

Presenter: Manuela De Allegri (University of Heidelberg. Institute of Public Health)

Abstract

Rationale
The Millenium Development Goals call for 75% reduction in maternal mortality by 2015. To achieve such an objective through increased utilisation of existing health services, many low and middle income countries have waived or substantially reduced user payments associated with maternal care. No evidence, however, is available on the effect of such policies on household expenditure on maternal care. This study aimed to assess the impact of policies waiving or substantially reducing user payments for maternal care on household health expenditure for such services.

Methods
The study was conducted in the Nouna Health District, in rural Burkina Faso (West Africa), a country which removed antenatal care (ANC) payments in 2006 and introduced a 80% subsidy for facility-based deliveries in 2007. Data were obtained through three cross-sectional surveys conducted during the dry season in 2006, 2007, and 2008. Each survey included 1050 households, selected using a two-stage cluster sampling procedure. Information on pregnancy, utilisation on ANC and facility-based delivery, including related expenditure, was collected for each woman who reported a pregnancy in the 12 months prior to the survey date. Household demographic and socio-economic information was also recorded. In addition to descriptive analysis, a Heckman-type correction was applied to the regression model to control for the bias arising from the fact that expenditure could only be observed for those households who reported that their pregnant women had used maternal care services. All regression models were subject to rigorous diagnostic tests.

Results
Following the introduction of the new policies, ANC utilisation (i.e. proportion of women attending at least 3 ANC visits) increased from 59% to 76% (p < 0.001) and facility-based deliveries from 49% to 68% (p < 0.001). The mean expenditure decreased significantly (p < 0.001) both for ANC and for facility-based deliveries, respectively from 890 to 280 CFA and from 4431 to 1755 CFA (1 Euro = 650 CFA). Determinants of expenditure on maternal care, however, did not vary significantly across the years. Household socio-economic status, women’s education, and urban residence were positively associated with the magnitude of the expenditure. Household head sex and education and proximity to a health facility did not affect the magnitude of the expenditure.

Conclusions
The results indicated that policies lowering financial barriers can be effective in increasing utilisation of maternal care services. Results, however, also showed that in spite of the newly introduced subsidies, household expenditure on maternal care does not drop to zero. The fact that the determinants of expenditure did not vary across the years suggests that access continues to be inequitable, with wealthier, better educated, urban women utilising and thus spending more on maternal care.

Key Terms

maternal care; access; household health expenditure

Authors:

Manuela De Allegri (University of Heidelberg. Institute of Public Health) , Subhash Pokhrel (Brunel University. Health Economics Research Group) , Valerie Louis (University of Heidelberg. Institute of Public Health) , Valéry Ridde (University of Montreal. Department of International Health) , Olaf Mueller (University of Heidelberg. Institute of Public Health) and Albrecht Jahn (University of Heidelberg. Institute of Public Health)

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