Out-of-pocket costs for facility-based maternity care in three African countries

Abstract

The majority of women interviewed reported paying out-of-pocket costs for facility-based deliveries. Out-of-pocket costs were highest in Kenya (a mean of US$18.4 for normal and complicated deliveries), where 98% of women who delivered in a health facility had to pay some fees. In Burkina Faso, 92% of women reported paying some fees (mean of US$7.9). Costs were lowest in Tanzania, where 91% of women reported paying some fees (mean of US$5.1). In all three countries, women in the poorest wealth quintile did not pay significantly less for maternity costs than the wealthiest women. Costs for complicated delivery were double those for normal delivery in Burkina Faso and Kenya, and represented more than 16% of mean monthly household income in Burkina Faso, and 35% in Kenya. In Tanzania and Burkina Faso most institutional births were at mid-level government health facilities (health centres or dispensaries). In contrast, in Kenya, 42% of births were at government hospitals, and 28% were at private or mission facilities, contributing to the overall higher costs in this country compared with Burkina Faso and Tanzania. However, among women delivering in government health facilities in Kenya, reported out-of-pocket costs were significantly lower in 2006 than in 2003, indicating that a 2004 national policy eliminating user fees at mid- and lower-level government health facilities was having some impact.

Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households

“…4,7,[20][21][22] The principal component analysis was based on ownership of certain household assets and on the quality of the house's construction materials. The wealth index was then divided into quintiles.…”

“…1 Emergency obstetric care, far more costly than normal delivery, can generate catastrophic expenses capable of pushing certain households below the poverty line or of plunging them deeper into poverty. [2][3][4][5][6] Several studies have explored the frequency of catastrophic health payments in sub-Saharan Africa, 1,7-10 but few of them have focused on catastrophic expenditure resulting from emergency obstetric care 5,6 and none has examined the factors that contribute to such expenditure. In addition, the ways in which households cope with these costs and their effects on their welfare have seldom been explored.…”

Mobiliser des représentations ethnoculturelles pour expliquer les disparités d’accès aux soins de santé au Burkina Faso

“…Les ménages payent le montant restant (20 % à 40 %). Avant la mise en oeuvre de cette subvention, un accouchement sans complication dans un centre de santé était estimé à environ 4 000 francs CFA* (9 CAD$) 13 . Grâce à celle-ci, les femmes ne devaient plus payer que 900 CFA (2 CAD$).…”

Emergency Obstetric Kits: Knowledge, Attitudes and Practices of Health Care Providers

“…oped to increase the use of obstetric services and improve the quality of emergency care [12]. It was in this context that each government was asked to mobilize all necessary resources to reduce deaths related to the third delay [13,14]. One of the main areas of intervention is to reduce the large catastrophic expenses incurred by families during childbirth [14].…”

“…It was in this context that each government was asked to mobilize all necessary resources to reduce deaths related to the third delay [13,14]. One of the main areas of intervention is to reduce the large catastrophic expenses incurred by families during childbirth [14]. In many countries, free care has been a means to reduce mortality by addressing financial barriers to access to quality childbirth [12,[15][16][17][18].…”