Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105105

Suneeta Sharma, PhD, MHA, Sarah Smith, MPH, Emily Sonneveldt, MPH, Marissa Pine, BA, and Varuni Dayaratna, MPA. Planning and Finance, The POLICY Project, Futures Group, One Thomas Circle, NW, Suite 200, Washington, DC 20005, 202-775-9680, ssharma@futuresgroup.com

User fees are becoming increasingly popular in government health programs to alleviate pressure on constrained budgets as demand for services increases. Concerns that fees reduce access to maternal health services among the poor have led to the promotion of fee exemption mechanisms as a means to protect the poor. While little is known about how well fee and waiver mechanisms function for maternal health services, it is important to know whether exemption mechanisms alone can protect access for the poor or whether other strategies need to be developed. This study was conducted simultaneously in five countries: Peru, Kenya, India (Uttranchal), Egypt, and Vietnam. The objectives were to: survey actual costs to consumers for antenatal and delivery care; survey current fee and waiver mechanisms; assess the degree to which these mechanisms function; assess the degree to which informal costs to consumers constitute a barrier to service; and review current policies and practices regarding setting fees and collecting, retaining, and utilizing revenue. The data analyzed includes government policies, facility records, household surveys, focus group discussions, facility surveys, and key informant interviews. The study found a low level of maternal health service utilization among the poor in all countries, with poor and not poor women benefiting equally from subsidized services. Poor women generally incurred substantial expenses for maternal health services in both public and private sectors with informal payments constituting a significant proportion of out-of-pocket expenses. Generally, women in all five countries were unaware of waiver and/or exemption mechanisms for maternal health services.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Identify financial barriers faced by women seeking maternal health services.
• Articulate the strengths and weaknesses of exemption and waiver mechanisms for maternal health services.
• Discuss the potential policy recommendations that would improve financial access to maternal health services among the poor.

Keywords: Access to Care, Financing

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation