The free delivery and caesarean policy in Morocco: how much do households still pay?

Abstract

Abstractbackground The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile.methods Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units.results Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites.conclusion The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes.

What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure

“…16 31 32 A study in Malawi interviewing patients undergoing hernia operations reported CE rates as high as 90% using a threshold of 10% of yearly income. 28 Various studies looking at injury and trauma care costs in Vietnam, India and Nigeria have reported CE rates of 60%, 30% and 86%, respectively, 25 and a study in Morocco looking at obstetric surgical care alone estimated CE rates of 88%, 33 while an emergency obstetric care study in Indonesia estimated CE at 68%. 34 The intercountry variability makes it difficult to draw comparative conclusions.…”

Out-of-pocket payment for surgery in Uganda: The rate of impoverishing and catastrophic expenditure at a government hospital

“…One study in Madagascar examined data from women undergoing cesarean section to extrapolate rates of impoverishing expenditure (IE) and catastrophic expenditure (CE) for all surgery as 77.4% to 86% and 78.8% to 95.1% respectively [ 23 ]. Catastrophic expenditure due to cesarean section has been estimated at 88% for the poorest quintile in Morocco [ 24 ] and between 1.6% and 22% in a single state in India [ 25 ]. Road traffic injuries have also been a focus of OOP.…”

Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review

“…Indeed, maternal mortality in Africa - in particular in SSA, which has remained which is indicative of the poor quality of maternal services - progressively declined over the last three decades [73]. We argue that the comparatively high adverse outcome associated with CSD in SSA is associated with vigorous policies, including, for instance, general practitioners, non-MD training [74] or free or the levying of a nominal fee by governments for CSDs [75,76]. Unfortunately, some countries like Morocco, rapidly lead to an alarming peak rate [77] Hopeful Results in the Reduction of the CSD Trend: Lessons from China China, in particular, is paving the way to address the CSD epidemic.…”