Subsidizing consumer cost for obstetrics and newborn care in Bangladesh: Opportunities and challenges

Maternal and child health programs are yet to achieve desired impact on the obstetric and newborn care services utilization from public-sector health facilities in Bangladesh. Home delivery and untrained providers largely contribute to the under utilization of the existing obstetric and newborn care services provided at facilities. Demand-side barriers particularly cost remains a key challenge to utilize MNCH care from facilities. This paper explains whether subsidized consumer cost increases utilization of obstetrics and newborn health service from facilities. Financial assistance in the form of coupon was provided to poor pregnant women to cover transportation and medical cost and also incidental cost for receiving services from facilities. A rigorous process consisting of community assessment and use of poverty tool was employed to select eligible women. Three-fourths of the poor pregnant women were identified as eligible for coupon distribution from 20,833 pregnant women from 2 northern districts. Seventy nine percent coupons were utilized for receiving the ANC services followed by institutional delivery (17%), PNC (16%), and pregnancy complications (13%) care. The most cited reason for non-use of coupon is inadequate knowledge about the coupon (41%), not perceiving the need to receive services from the health facilities (22%) and transportation cost (9%). Round trip transportation costs and intensive advocacy at the community will increase the coupon use.