Financing maternal health Flashcards
SDG goals in relation to maternal health and mortality
By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births.
(Problem = countries with lowest maternal mortality ratio typically have the lowest birth/natality rates)
Why is maternal mortality often described as ‘a road to death’?
Maternal mortality is typically multifactorial (a lot of factors increase the risk women face along the way)
e.g.
- low education
- little money
- many children per woman
- anaemia
- distance from a health facility
- travel costs
- too few health facilities
- too little skilled health providers
- too few drugs
- too few blood transfusions
Main reason for existence of user fees?
A country does not have sufficient funds to finance healthcare (e.g. from taxes or another source of revenue)
WHO recommended maternal services to be provided
- antenatal care (at least 4 times)
- routine impartum care (at birth)
- emergency obstetric care (e.g. C section, if there are complications)
- postpartum care (3 or more) (e.g. are antibiotics needed, are there breastfeeding issues etc)
Typical levels of healthcare delivery in low-income countries?
- Region
- District
- Division
- Village
(District health systems are an important feature!!)
Explain the concept of ‘empty services’
Facilities which exist but cannot operate sufficiently because of a lack of resources (e.g. a health center with no medication, too few HCPs etc)
Typical features of healthcare financing in low income countries? ( + how does this compare to a high income country)
- limited amount of government transfers (tax contributions)
- presence of external aids (% of THE variable)
- high out-of-pocket spending
- low social health insurance and voluntary health insurance contributions
(in a high income country, majority of funding will come from gov transfers if tax based system or SHI contributions if SHI system, while the remaining will come from OOP spending)
Healthcare financing; example sources
- Firms, corporate entities and employers
- Individuals, households and employees
- Foreign and domestic NGOs and charities
- Foreign govt and companies
Healthcare financing; example mechanisms
- Direct and indirect taxes
- Compulsory insurance contributions and payroll taxes
- Voluntary insurance premiums
-Medical savings accounts - Out-of-pocket payments
- Loans, grants and donations
Healthcare financing; example collection agents
- Central, regional and local government
- Independent public body or social security agency
- Private not-for-profit or for-profit insurance funds
- Providers
Describe the ‘wave’ of user fee reforms in West Africa
Historical context:
1987 Bamako initiative – in the context of neoliberal financial strategies and largely empty health services (no drugs, providers not paid, etc)
(The Bamako Initiative was agreed by African Ministers of Health in 1987 with WHO and UNICEF, calling for community participation in managing and funding supplies of essential drugs.)
- initiative aimed at solving the problems in the financing of primary health care in SSA
‘We first show that a general consensus has emerged internationally against user fees, which were imposed widely in Africa in the 1980s and 1990s; at that time, the institutionalization of user fees was supported by evidence from pilot projects funded by international aid agencies. Since then there have been other pilot projects studying the abolition of user fees in the 2000s, but these have not yet had any real influence on public policies, which are often still chaotic. This perplexing situation might be explained more by ideologies and political will than by insufficient financial capacity of states.’
Problems with OOP
- unmet need of health and medical care
- catastrophic health expenditure
- economic impoverishment/poverty
(+ people are not inclined to pay for preventive services//pay before they have a health issue)
DHS Program (Demographic and Health Surveys)
- household surveys on health
- started in 1980s
The Demographic and Health Surveys (DHS) Program has collected, analyzed, and disseminated accurate and representative data on population, health, HIV, and nutrition through more than 400 surveys in over 90 countries.
User fee exemptions - points to keep in mind
- Often focused on maternal and child health services
- Complex to implement
- Important to realize potential negative “side-effects” (e.g. flawed incentives, if you make only C section free, women might want to deliver that way even if there is no need)
