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 shouldbe able to access timely interventions during pregnancy, delivery and in thefirst few months after birth. However, demand for maternal health services is severelyaffected by the cost to the household of seeking care, exacerbated bygeographical and cultural barriers and poor quality care.

There is ashortage of adequately trained health professionals and health facilities arenot properly equipped due to insufficient investment in maternal healthservices. If maternal health interventions are to be scaled up and the globalburden of maternal ill health decreased, a considerable effort is needed toreach those who are currently excluded from this care.

A review in TheLancet Maternal Survival Series states the case for investing in maternalhealth. It looks at how financial resources can be directed to maternal health serviceswithin countries, assesses the successes and shortcomings of conventionalfinancing methods and proposes alternative approaches. Key findings include:

• Thecase for public investment in maternal health care is strong and includessaving the lives of both mothers and newborns, improving the life chances ofolder children, benefiting health service delivery generally and contributing topoverty alleviation.
• Poor peopleneed financial protection to encourage them to seek maternal health services.
• Userfees hurt the poorest people and prevent them from accessing maternal health services.
• Transportand time costs can be considerable and these are generally not addressed byconventional financing arrangements.
• Insuranceschemes struggle to reach the poorest people in rural areas due to thedistribution of households, low incomes, little formal employment and very littlehealth care infrastructure.
• Voucherschemes and cash transfers have been introduced in some settings to improveaccess to maternal health services. However, little is known about the impactof these schemes in low income settings and their cost relative to otherschemes.

Financialinvestment in maternal health has clear health and social benefits. The reportmakes a wide range of policy recommendations, including the following:

• Theevidence suggests a strong case for removing user fees and providing universalcoverage for pregnant women, especially for care during delivery.
• Governmentswill need to find ways to replace the income lost through removing user fees.
• Insuranceschemes must include maternal health care and make sure the poorest areinsured.
• Governmentsmust choose financing strategies that are suited to their local context,estimate the resources needed to implement the strategies, lobby for morefunding and prove that the funds are used effectively.
• The internationalcommunity will need to commit additional resources to maternal health as currentlevels of investment are too low to reach the Millennium Development Goal Fiveof reducing maternal deaths by 75 percent by 2015.