User fees and maternity services in Ethiopia

Abstract

Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under discussion.

Health Care Financing in Ethiopia: Implications on Access to Essential Medicines

“…Until recently, the fee waiver system was characterized by ineffectiveness in specifically targeting the poor, incompleteness of coverage of services, and lack of proper documentation [18][19][20]. Although some reports suggest betterment of services with user fees, there is an apparent "crowding out effect" of fee increment by public health facilities, especially on the poor segments of the society in the absence of protective mechanisms [19][20][21].…”

“…Generally, the reviewed sources showed that the Ethiopian society is highly exposed to increasing user fees for health care services and adverse effects of out-of-pocket expenditures for health care. Risk protection systems are at their level of infancy in Ethiopia [16,[18][19][20]34].…”

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

“…Only 2.8% Table 4: Attitude of health care providers towards delivery kits stock-outs. 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]. 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]. In Cameroon, after the intervention of the PASSAGE project, the strategy of pre-positioning of kits had been effective since 2011.…”

Sexual and reproductive health and rights in changing health systems

“…This has been especially detrimental for vulnerable groups with limited access to financial resources (i.e., adolescents, elderly, women engaged in the informal economy; Parkhurst et al, 2005;WHO, 2010a). Childbirth services (including caesarean sections) have been found unaffordable and in some instances involve catastrophic costs across a range of LMICs (Honda, Randaoharison, & Matsui, 2011;Pearson, Gandhi, Admasu, & Keyes, 2011;Titaley, Hunter, Dibley, & Heywood, 2010). This is described further in the commentary on China (Fang, 2014).…”