Subsidizing Maternal Health Services Cost to Improve Utilization

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.