An ex-ante economic evaluation of the Maternal and Child Health Voucher Scheme as a decision-making tool in Myanmar

Abstract

Reducing child and maternal mortality in order to meet the health-related Millennium Development Goals (MDGs) 4 and 5 remains a major challenge in Myanmar. Inadequate care during pregnancy and labour plays an important role in the maternal mortality rate in Myanmar. A Maternal and Child Health (MCH) Voucher Scheme comprising a subsidization for pregnant women to receive four antenatal care (ANC), delivery and postnatal care (PNC) free-of-charge was planned to help women overcome financial barriers in addition to raising awareness of ANC and delivery with skilled birth attendants (SBA), which can reduce the rate of maternal and neonatal death. This study is part of an ex-ante evaluation of a feasibility study of the MCH Voucher Scheme. A cost-utility analysis was conducted using a decision tree model to assess the cost per disability-adjusted life years (DALYs) averted from the MCH Voucher Scheme compared with the current situation. Most input parameters were obtained from Myanmar context. From the base-case analysis, where the financial burden on households was fully subsidized, the MCH Voucher Scheme increased utilization for ANC from 73% up to 93% and for delivery from SBAs from 51% up to and 71%, respectively; hence, it is considered to be very cost-effective with an incremental cost-effectiveness ratio of 381 027 kyats per DALY averted (2010, price year). From the probabilistic sensitivity analysis, the MCH Voucher Scheme had a 52% chance of being a cost-effective option at 1 GDP per capita threshold compared to the current situation. Given that the Voucher Scheme is currently being implemented in one township in Myanmar as a result of this study, ongoing evaluation of the effectiveness and cost-effectiveness of this scheme is warranted.

Key factors deterring women's engagement with skilled birth attendants in three districts of Timor—Leste. A qualitative descriptive study

“…In addition, socioeconomically disadvantaged women's uptake of SBA services may be improved with the provision of inducements offered to the mother, such as vouchers or postnatal packs. These have demonstrated potential to improve uptake of SBA in other countries (Hunter & Murray, 2017;Kingkaew et al, 2016).…”

Cost effectiveness of mHealth intervention by community health workers for reducing maternal and newborn mortality in rural Uttar Pradesh, India

“…The decision tree models have been used in cost effectiveness studies across the globe specifically to calculate the incremental cost effectiveness ratios of various maternal and newborn programs. For instance, to calculate cost effectiveness of ‘Integrated Management of Newborn and Childhood Illnesses’ program in India [ 37 ]; group B streptococcal vaccine immunization to prevent neonatal sepsis and meningitis in Sub Saharan Africa [ 77 ]; voucher scheme combined with obstetrical quality improvements as a part of quasi experimental results from Uganda [ 78 ] and maternal and Child health voucher scheme in Myanmar [ 79 ].…”

How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India

“…Over the last three decades, policy focus has shifted to increase the demand for MCHC services by increasing the purchasing power of poor people. Since the 1990s, several developing countries have started conditional cash transfer programs, traditionally called demand-side financing (DSF) programs, to increase the purchasing power of disadvantaged women (Ensor et al, 2017;Yang et al, 2016;Kuwawenaruwa et al, 2016;Kingkaew et al, 2016;Engineer et al, 2016;Skiles et al, 2015).…”