Effectiveness of demand side financing on increasing the demand for maternal health care among the Bangladeshi women: Study in selected areas

Abstract

In developing countries like Bangladesh, Government health facilities provide free ANC, delivery and PNC services, but the related costs like medicines, transportation and treatment discourage many poor women from seeking these services. To tackle such financial barriers to access, these countries are implementing various demand-side approaches to financing health care that subsidize the poor pregnant women directly. The Government of Bangladesh has launched a DSF program or voucher scheme with vouchers being distributed to poor pregnant women ensuring them to access free antenatal, delivery, emergency referral, and postpartum care services. The overall objective of the study is to assess the effectiveness of demand side financing on increasing the demand for maternal health care. The specific objectives are: i) To assess the socio-economic status of respondents. ii) To see the health care seeking behaviour of woman with respect to ANC, delivery care & PNC in an experimental area (where DSF is performed) and a control area (where DSF is not performed). iii) To examine the effectiveness of DSF on increased utilization of ANC, delivery care, delivery care attended by skilled birth attendants, PNC and reduction of child and maternal mortality rate. An experimental design of survey was conducted by purposively selecting Raipura upazila of Narshingdi district having DSF (voucher scheme) intervention as experimental area and Araihazar upazila of Narayangonj district having no DSF intervention as control area. A total of 480 women (240 from experimental area and 240 from control area) and 15 service providers (from experimental area) were interviewed during 01 September to 30 October 2013 for collection of primary data on the issue. The study reveals that women in the experimental area have higher family income, higher family size, higher education but lower age compared to the control area. More women in the experimental area have better knowledge about the recommended number of ANC visits than the control area. More than half of the women of experimental area received ANC three times during their last pregnancy but half of the women in control area did not receive ANC at all. About 84% of women of experimental area visited UHC for ANC check up but it is only 41.8% in control area who visited private hospital/clinic. More women in the experimental area have TT injections (60.4%) and have pathological test (72.1%) than the control area (31.7% & 35.4% respectively). As expected complications experienced by the women are much lower (19.0%) in experimental area compared to control area (30.8%). A larger proportion of women (48.3%) of experimental area went UHC for their delivery and most of the women (66.2%) of control area preferred home for delivery during their last pregnancy. Normal delivery is almost the same at both the areas but percentage of c-section is a little bit higher in experimental area than the control area. The deliveries conducted by the skilled personnel are higher in the experimental area (64.6%) compared to the control area (41.6%). About 6% women in experimental area and about 23% women in control area reported that they did not experience any complication during their last delivery. 31.7% of women in experiment area and 19.6% of women in the control area had a PNC visit. Most of the women (71.4%) received PNC by qualified person like Doctor, MA, nurses etc. at UHC in experimental area and majority of the women (59.6%) in the control area received PNC at private hospital/clinic. The higher proportion of women in the experimental area compared to the control area have breastfed the last child and have had their child in taking of vitamin A capsule. The lesser proportion of women in the experimental area has experienced miscarriage or abortion or still birth or MR than the control area. Number of child death appears to be lower in the experimental area compared to the control area. The maternal and child mortality rates appear to be lower in the experimental area due to consuming more MHC services by the poor women in comparison with the control area. However, cash incentives for the voucher recipients are found to be an important factor for the positive impact on the demand for and the utilization of MHC among the women in the experimental/ program area.