215755 Subsidizing Maternal Health Services Cost to Improve Utilization

Wednesday, November 10, 2010

Haris Ahmed , Pathfinder International, Deputy Project Director, Islamabad, Pakistan
Background: In Pakistan MMR stands at 270 deaths per 100,000 births. Almost 65% women deliver at home. For 38% women delivering a baby at facility are costly as compare to home and for 47% women who have a complication, cost of treatment curtail them from seeking care. A small scale pilot was launched in September 2008 under a donor funded project in six Union Councils of DGKhan city of Southern Punjab to increase use of maternal health services Design and Method: Twenty private sector providers signed up. Beneficiaries were 1,999 pregnant women with an average household income less than US$80.00 and a history of home deliveries. A set of nine vouchers was sold at a subsidized rate of US$1.2. The services offered included three antenatal visits, two tetanus toxoid injections, ultra-sonography, blood test, normal delivery or caesarean section, postnatal visit and family planning consultation and service. Every voucher was coded. Women received free services worth US$44.00 (normal delivery) / US$121.00 (caesarean section). Providers compensated on monthly basis after verification. Clients paid for transportation.

Results / Outcomes: In one year 95% of vouchers were redeemed. 92% women received antenatal care, 67% had a lab investigations and 84% an ultrasonograpgy. Tetanus immunization was 86%. Facility based deliveries were 96%. Caesarean sections were 13%. Postnatal care was 87% women, 94% of these took family spacing consultation and 68% used a method.

Conclusions: This initiative has increased use of health services by target populations, engage private sector, and improved quality of service by providers.

Learning Areas:
Biostatistics, economics
Provision of health care to the public

Learning Objectives:
Demand-side financing programs have gained importance as they increase access and utilization to health services. By the end of this presentation participants can appreciate how a small scale pilot of output-based program to improve maternal health services in Pakistan has attracted donors for a scale up.

Keywords: Access and Services, Maternal Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have designed and implemented this intervention
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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