Mapping evidence of free maternal healthcare financing and quality of care in sub-Saharan Africa: a systematic scoping review protocol

Ansu-Mensah, Monica; Mohammed, Tahiru; Udoh, Roseline H.; Bawontuo, Vitalis; Kuupiel, Desmond

doi:10.1186/s12961-019-0495-1

Cited by 5 publications

(4 citation statements)

References 20 publications

(15 reference statements)

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“…The majority of sub-Saharan African countries have implemented free maternal and child health policies. 21 However, many women still face considerable difficulty accessing services as they are exposed to direct costs (eg, payments for medication and laboratory tests) and indirect costs (eg, transportation). 21 In countries such as Angola, Togo, Nigeria and Ethiopia that reported low rates of SBA and CS, we found strong pro-rich inequalities.…”

Section: Discussionmentioning

confidence: 99%

“… 21 However, many women still face considerable difficulty accessing services as they are exposed to direct costs (eg, payments for medication and laboratory tests) and indirect costs (eg, transportation). 21 In countries such as Angola, Togo, Nigeria and Ethiopia that reported low rates of SBA and CS, we found strong pro-rich inequalities. In these countries, the World Bank reports that out of pocket health expenditure exceeds 35% of current expenditure and is as high as 62% in Chad and 77% in Nigeria suggesting a high burden of cost on the poor.…”

Section: Discussionmentioning

confidence: 99%

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Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

et al. 2021

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BackgroundImproved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa.MethodsWe analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section.ResultsThe rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section.ConclusionsThere were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

et al. 2021

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“…We used Arksey and O’Malley’s framework as a guide to conduct a scoping review. The protocol of this study was developed and published elsewhere [ 16 ]. We followed the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist to report this study.…”

Section: Methodsmentioning

confidence: 99%

Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

Ansu-Mensah

Danquah

Bawontuo

et al. 2021

BMC Pregnancy Childbirth

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Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

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“…In many Sub-Saharan African countries, health insurance schemes have played a key role in facilitating access and use of maternal health services and promoting a significant reduction of the high maternal morbidity and mortality in the sub-region [6,7]. Health insurance schemes have also positively impacted increased services utilisation by pregnant women in Senegal and Mali [7], skilled birth delivery in Rwanda [8], and utilisation of postnatal care in Mauritania [9].…”

Section: Introductionmentioning

confidence: 99%

The effect of the capitation policy withdrawal on maternal health service provision in Ashanti Region, Ghana: an interrupted time series analysis

Yambah

Mensah

Kuunibe

et al. 2022

glob health res policy

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Background Payment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap. Methods We used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4+ (visits of pregnant women making at least the fourth antenatal care attendance per month), HB36 (number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation) and vaginal delivery in capitated facilities-CHPS (Community-based Health Planning and Services) facilities and hospitals. Results The results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+ in hospitals (coefficient 70.99 p < 0. 001) but no effect in CHPS facilities. Also, the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36; a statistically significant decline was observed in CHPS (coefficient − 7.01, p < 0.05) while that of hospitals showed a statistically significant trend increase (coefficient 32.87, p < 0.001). Finally, the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals. Conclusions The capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals; repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities. Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.

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Mapping evidence of free maternal healthcare financing and quality of care in sub-Saharan Africa: a systematic scoping review protocol

Cited by 5 publications

References 20 publications

Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

The effect of the capitation policy withdrawal on maternal health service provision in Ashanti Region, Ghana: an interrupted time series analysis

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