Maternal Health Care Expenditure among Women in Rural Areas of Pakistan

et al. 2021

BMC Health Serv Res

Background This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare. Methods The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests. Results The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs = 0.095, p = 0.002) and the number of pregnancies (rs = − 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05). Conclusion Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.

Section: Discussionsupporting

confidence: 77%

“…High OOPE is a barrier to affordability and accessibility creating inequities in maternal health [28,29]. Studies performed in low and middleincome countries (LMICs) such as India [35], Pakistan [36], Zambia [37], and Ghana [38] revealed that OOPE is a significant barrier to optimal maternal care.…”

Section: Introductionmentioning

confidence: 99%

How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

et al. 2021

BMC Health Serv Res

“…The positive correlation between OOPE and household expenditure is oblivious since OOPE acts as an independent health cost category, including medical and non-medical spending, which is in line with the existing evidence (59). The number of pregnancies reported a negative association with OOPE; a study conducted in India revealed a similar association (25). The probable reason could be better nancial management during pregnancy with previous experience.…”

Section: Discussionmentioning

confidence: 83%

“…High OOPE is a barrier to affordability and accessibility creating inequities in maternal health (21,22). Studies performed in low and middle-income countries (LMICs) such as India (24), Pakistan (25), Zambia (26), and Ghana (27) revealed that OOPE is a signi cant barrier to optimal maternal care.…”

Section: Introductionmentioning

confidence: 99%

How Costly is the First Prenatal Clinic Visit? Analysis of Out-of-Pocket Expenditure in Rural Sri Lanka - A Country With Free Maternal Health Care

et al. 2021

Preprint

Background: This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare. Methods: The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health areas in Anuradhapura District, Sri Lanka. Data of 1,389 pregnant women were analyzed using descriptive statistics and non-parametric tests. Results: The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9% and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs=0.095, p=0.002) and the number of pregnancies (rs=-0.155, p<0.001) with OOPE. Conclusion: Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost.

“…Further, there was a negative relationship between the number of previous pregnancies and the magnitude of the OOPE. It is due to the experience gained in previous pregnancies that may have led to better nancial management, as con rmed in the studies done in Sri Lanka (40) and India (31). Also, it could be assumed that the lower OOPE occurs for subsequent pregnancies due to less anxiety, concern, and lack of time to pay attention to health seeking.…”

Section: Discussionmentioning

confidence: 96%

Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

et al. 2022

Preprint

Background: Out-of-pocket expenditure (OOPE) considers a barrier to access to healthcare for pregnant women. This study aimed to estimate the magnitude and associated factors of OOPE for antenatal care (ANC) in a rural Sri Lankan setting. Methods: This study was a follow-up of a large pregnancy cohort [Rajarata Pregnancy Cohort (RaPCo)] in all 22 Medical Officers of Health areas in the Anuradhapura District, Sri Lanka. A pre-tested interviewer-administered questionnaire was used to collect data on socio-demographic, economic, and the cost incurred in the first trimester, and self-administered questionnaires were used monthly to collect costs incurred in the second and third trimesters. In-depth financial information of 1,558 pregnant women was analyzed using descriptive statistics for the magnitude, non-parametric statistical methods for statistically significant difference, and the multiple linear regression model to test the associated factors. Results: The mean (SD)]age of the pregnant women was 28.3 (5.6) years. The mean (SD) monthly household income and expenditure were USD 277.29 (216.04) and USD 190.19 (103.11), respectively. The mean OOPE for per visit ANC was USD 4.18 (52.1% of per day household expenditure). The mean OOPE for total ANC was USD 57.74 (3.4% of annual household expenditure). The direct medical OOPE share (73.8%) was significantly higher than direct non-medical OOPE (26.2%) (p<0.001). Pregnant women who utilized only the government-free health services also spent 28% and 14% of OOPE on medicines and laboratory investigations. Monthly household income (p<0.001), monthly household expenditure (p<0.1), used healthcare mode (p<0.05), having maternal morbidities (p<0.05), and the number of previous pregnancies (p<0.1) were the statistically significant independent predictors of OOPE during ANC.Conclusion: Per visit OOPE for ANC is equivalent to half of the per day household expenditure. Monthly household income, expenditure, used healthcare mode, maternal morbidities, and the number of previous pregnancies are independent predictors of OOPE during ANC. Despite having freely available government health facilities, the majority tend to use private health facilities and incur higher OOPE. Government-free healthcare users also incur a direct medical OOPE for medicines and laboratory investigations.