Increasing access to maternal care through vouchers in Bangladesh
Presentation at the 36th International Conference on Global Health, Washington DC, 27 May
Publication date: 2009
At the conclusion of this session, participants will be able to: (1) understand how poor pregnant women were selected for vouchers jointly by field workers and community support group members; (2) know how the institutionalization process for the voucher scheme was implemented; and (3) identify how the health facilities were strengthened to provide high-quality maternal health care.
Bangladesh has made significant progress in reducing fertility as well as reducing infant and child mortality. However, there remain principal health development challenges in further reducing maternal deaths and attaining replacement-level fertility. Improvement in the unacceptably high maternal mortality rate is the key issue of the current government programs and policies. Low utilization of maternity care provided by trained professionals is influenced primarily by demand-side barriers, one of which is cost. The government health facilities provide free antenatal care (ANC), delivery, and postnatal care (PNC) services, but the costs of medicines and surgical procedures for complications are currently not fully covered. Financial assistance through subsidized vouchers has been tested in Bangladesh as one way of enabling poor women to receive life-saving obstetric care services.
The overall objective of the study was to test the feasibility and effectiveness of a voucher scheme to increase the availability for poor rural women of pregnancy-related services from trained providers. A pretest-posttest design was used to evaluate the voucher scheme over a nine-month duration.
Findings suggest that the voucher scheme, coupled with awareness-raising activities through community involvement, can be an effective strategy to increase utilization of trained providers during pregnancy; introduction of the maternal health voucher scheme increased utilization of health facilities for maternity services. Among those women who received vouchers, 89 percent received at least one ANC service from a trained provider compared with 41 percent at baseline. The proportion of deliveries assisted by trained providers increased from 6 percent to 22 percent and institutional deliveries increased from 2 percent to 18 percent. Clients receiving PNC services increased from 10 percent to 60 percent.
The "hands-on" training increased the confidence of service providers in performing normal deliveries at primary-level health facilities, but periodic refresher training and supportive supervision is needed to improve and sustain the quality of counseling and services.
Population Council, UNFPA, CIDA, and RTM International.