Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India

Govil, Dipti; Purohit, Neetu; Gupta, Shiv Dutt; Mohanty, Sanjay K.

doi:10.1186/s41043-016-0051-3

Cited by 31 publications

(46 citation statements)

References 47 publications

(34 reference statements)

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“…The average cost of the package of four antenatal care visits during pregnancy was $44 across the five public facilities and $160 in the private facility. A similar finding was documented in India, where the cost of antenatal care provision in private health facilities was more than double the cost of public sector provision [ 26 ]. In our study, the higher cost of ANC in the private clinic can be partly explained by the highly qualified and better-remunerated staff compared to public health facilities surveyed in this study.…”

Section: Discussionsupporting

confidence: 79%

Cost of antenatal care for the health sector and for households in Rwanda

Hitimana

Lindholm

Krantz

et al. 2018

BMC Health Serv Res

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BackgroundRwanda has made tremendous progress in reduction of maternal mortality in the last twenty years. Antenatal care is believed to have played a role in that progress. In late 2016, the World Health Organization published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other changes. There is ongoing debate regarding the cost implications and potential outcomes countries can expect, if they make that shift. For Rwanda, a necessary starting point is to understand the cost of current antenatal care practice, which, according to our knowledge, has not been documented so far.MethodsCost information was collected from Kigali City and Northern province of Rwanda through two cross-sectional surveys: a household-based survey among women who had delivered a year before the interview (N = 922) and a health facility survey in three public, two faith-based, and one private health facility. A micro costing approach was used to collect health facility data. Household costs included time and transport. Results are reported in 2015 USD.ResultsThe societal cost (household + health facility) of antenatal care for the four visits according to current Rwandan guidelines was estimated at $160 in the private health facility and $44 in public and faith-based health facilities. The first visit had the highest cost ($75 in private and $21 in public and faith-based health facilities) compared to the three other visits. Drugs and consumables were the main input category accounting for 54% of the total cost in the private health facility and for 73% in the public and faith-based health facilities.ConclusionsThe unit cost of providing antenatal care services is considerably lower in public than in private health facilities. The household cost represents a small proportion of the total, ranging between 3% and 7%; however, it is meaningful for low-income families. There is a need to do profound equity analysis regarding the accessibility and use of antenatal care services, and to consider ways to reduce households’ time cost as a possible barrier to the use of antenatal care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3013-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 79%

Cost of antenatal care for the health sector and for households in Rwanda

Hitimana

Lindholm

Krantz

et al. 2018

BMC Health Serv Res

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“…CHCs, due to a lighter load of childbirths, are better able to keep the perinatal care wards prepared for women. While other Indian studies describe a shortage of infrastructure, material and supply to support increased numbers of institutional childbirths [39,40,56], our review did not reveal other quantitative studies to prove or disprove our interpretations.…”

Section: Discussioncontrasting

confidence: 69%

“…The multi-front promotion of institutional childbirths by the Government of India has resulted in an exponentially increasing number of women coming to hospitals with the chief expectation of ensuring the safety of themselves and their neonates [35–38]. However, the expansion in the number of labour rooms and necessary resources and infrastructure, especially in public health facilities, has not been proportional to rising demand [36,39,40]. Labour rooms have become crowded and understaffed and face shortages of equipment and material [17,40] and the documentation processes around childbirth have been described to be ‘too much to do concurrently with actual care provision’, with care providers relying on verbal communication rather than maintaining written documentation of decision-making around childbirth [17,41].…”

Section: Introductionmentioning

confidence: 99%

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

Jha

Larsson

Christensson

et al. 2017

Global Health Action

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Background: A woman’s satisfaction with childbirth services can have a significant impact on her mental health and ability to bond with her neonate. Knowing postnatal women’s opinions and satisfaction with services makes the services more women-friendly. Indian women’s satisfaction with childbirth services has been explored qualitatively, or by using non-standard local questionnaires, but scientific data gathered with standardised questionnaires are extremely limited. Objective: To measure postnatal Indian women’s satisfaction with childbirth services at selected public health facilities in Chhattisgarh, India. Methods: Cross-sectional survey using consecutive sampling (n = 1004) was conducted from March to May 2015. Hindi-translated and validated versions of the Scale for Measuring Maternal Satisfaction for Vaginal Births (VB) and Caesarean Births (CB) were used for data collection. Results: Although most of the women (VB 68.7%; CB 79.2%) were satisfied with the overall childbirth services received, those who had VB were least satisfied with the processes around meeting their neonates (mean subscale score 1.8, SD 1.3), while women having CB were least satisfied with postpartum care received (mean subscale score 2.7, SD 1.2). Regression analyses revealed that among women having VB, interacting with care providers, being able to maintain privacy, and being free from fear of childbirth had a positive influence on overall satisfaction with the childbirth. Among women having CB, earning their own salary and having a positive perception of self-health had associations with overall birth satisfaction. Conclusions: Improving interpersonal interaction with nurse-midwives, and ensuring privacy during childbirth and hospital stay, are recommended first steps to improve women’s childbirth satisfaction, until the supply gap is eliminated.

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“…Similarly, a study in a rural setting in Nigeria, West Africa, showed that women and their families spent between US$9 and US$99 for use of maternal health services [ 37 ]. In India too, a recent study reported that households incurred a mean OOP expenditure of US$ 26 in public health facilities for the utilisation of maternal health services [ 38 ]. These studies bear resemblance to our study, given that the mean OOP costs were for use of maternal health services in public health facilities in the midst of fee exemptions or health insurance.…”

Section: Discussionmentioning

confidence: 99%

Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana

2018

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IntroductionThe free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored.MethodsA convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women’s perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes.ResultsThe NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy.ConclusionWomen needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.

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Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India

Cited by 31 publications

References 47 publications

Cost of antenatal care for the health sector and for households in Rwanda

Cost of antenatal care for the health sector and for households in Rwanda

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana

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