Reducing the cost of maternal health services to the poorest households

Insufficient supply and limited demand among many of the poorest people mean that maternal health services often do not reach all who need care. Poor households often pay a high proportion of the costs of maternal health services and many do not access the services because they cannot afford to. How can the burden of costs be reduced?

All women should be able to access timely interventions during pregnancy, delivery and in the first few months after birth. However, demand for maternal health services is severely affected by the cost to the household of seeking care, exacerbated by geographical and cultural barriers and poor quality care.

There is a shortage of adequately trained health professionals and health facilities are not properly equipped due to insufficient investment in maternal health services. If maternal health interventions are to be scaled up and the global burden of maternal ill health decreased, a considerable effort is needed to reach those who are currently excluded from this care.

A review in The Lancet Maternal Survival Series states the case for investing in maternal health. It looks at how financial resources can be directed to maternal health services within countries, assesses the successes and shortcomings of conventional financing methods and proposes alternative approaches. Key findings include:

• The case for public investment in maternal health care is strong and includes saving the lives of both mothers and newborns, improving the life chances of older children, benefiting health service delivery generally and contributing to poverty alleviation.
• Poor people need financial protection to encourage them to seek maternal health services.
• User fees hurt the poorest people and prevent them from accessing maternal health services.
• Transport and time costs can be considerable and these are generally not addressed by conventional financing arrangements.
• Insurance schemes struggle to reach the poorest people in rural areas due to the distribution of households, low incomes, little formal employment and very little health care infrastructure.
• Voucher schemes and cash transfers have been introduced in some settings to improve access to maternal health services. However, little is known about the impact of these schemes in low income settings and their cost relative to other schemes.

Financial investment in maternal health has clear health and social benefits. The report makes a wide range of policy recommendations, including the following:

• The evidence suggests a strong case for removing user fees and providing universal coverage for pregnant women, especially for care during delivery.
• Governments will need to find ways to replace the income lost through removing user fees.
• Insurance schemes must include maternal health care and make sure the poorest are insured.
• Governments must choose financing strategies that are suited to their local context, estimate the resources needed to implement the strategies, lobby for more funding and prove that the funds are used effectively.
• The international community will need to commit additional resources to maternal health as current levels of investment are too low to reach the Millennium Development Goal Five of reducing maternal deaths by 75 percent by 2015.

Source(s):
‘Mobilising financial resources for maternal health’, The Lancet Maternal Survival Series 368(9545), pages 1457-1465, by Jo Borghi, Tim Ensor, Aparnaa Somanathan, Craig Lissner and Anne Mills, 2006 Full document.

Funded by: UK Department for International Development (DFID); US Agency for International Development (USAID); Initiative for Maternal Mortality Programme Assessment (IMMPACT)

id21 Research Highlight: 16 January 2007

Further Information:
Anne Mills
Health Economics and Financing Programme
London School of Hygiene & Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0) 20 79272354
Fax: +44 (0) 20 76375391
Contact the contributor: anne.mills@lshtm.ac.uk

Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, UK

Institute of Child Health, University of London, UK

Department of Obstetrics and Gynaecology, University of Aberdeen, UK

Other related links:
Initiative for Maternal Mortality Programme Assessment (IMMPACT)

'Understanding maternal mortality: achieving the fith Millennium Development Goal'

'Professional maternity care: scaling up provision in poor countries'

'Reducing maternal mortality: what strategies work?'

'Women's groups' perceptions of maternal health issues in rural Malawi'

'Maternal health in sub-Saharan Africa: tackling the skills shortage'

'Making childbirth safer for mothers in Nepal'