Assessing regional variations in the effect of the removal of user fees on facility-based deliveries in rural Zambia.

Chama-Chiliba Chitalu,Koch Steven

doi:10.4314/ahs.v17i4.28

Abstract

Maternal health remains a concern in sub-Saharan Africa, where maternal mortality averages 680 per 100,000 live births and almost 50% of the approximately 350,000 annual maternal deaths occur. Improving access to skilled birth assistance is paramount to reducing this average, and user fee reductions could help. The aim of this research was to analyse the effect of user fee removal in rural areas of Zambia on the use of health facilities for childbirth. The analysis incorporates supply-side factors, including quantitative measures of service quality in the assessment. The analysis uses quarterly longitudinal data covering 2003 (q1)-2008 (q4) and controls for unobserved heterogeneity, spatial dependence and quantitative supply-side factors within an Interrupted Time Series design. User fee removal was found to initially increase aggregate facility-based deliveries. Drug availability, the presence of traditional birth attendants, social factors and cultural factors also influenced facility-based deliveries at the national level. Although user fees matter, to a degree, service quality is a relatively more important contributor to the promotion of facility-based deliveries. Thus, in the short-term, strengthening and improving community-based interventions could lead to further increases in facility-based deliveries.

Highlights

Maternal health remains a global challenge in sub-Saharan Africa, where maternal mortality averages 680 per 100,000 live births and almost 50% of the approximately 350,000 annual maternal deaths occur.[1,2] There is a need to further facilitate skilled birth assistance and facility-based deliveries (FBDs),[2,3,4] because skilled birth assistance is the single most important factor in preventing maternal deaths.[5]
The mean differences do not account for other factors, while the standard errors do not account for within-group correlation
The correlation between ID and traditional birth attendant (TBA) is negative and significant, both ID and TBA are significantly correlated to the other regional control variables (ANC, Drug availability (DA), contacts per day (CC) and population in the province (POP))

Summary

Introduction

Maternal health remains a global challenge in sub-Saharan Africa, where maternal mortality averages 680 per 100,000 live births and almost 50% of the approximately 350,000 annual maternal deaths occur.[1,2] There is a need to further facilitate skilled birth assistance and facility-based deliveries (FBDs),[2,3,4] because skilled birth assistance is the single most important factor in preventing maternal deaths.[5]. The limited use of FBDs is expected to relate to barriers deterring women.[8,9,10,11,12,13] User fees are one such (financial) barrier discouraging FBD utilisation.[10,14,15,16] Health system factors such as quality matter.[17] the importance of quality has been confirmed in qualitative study,[18] few quantitative studies manage to capture the quality of care. In the African context, the primary alternative is a traditional birth attendant (TBA), an alternative that may or may not be an appropriate substitute, due to low levels of literacy, nonexistant to poor training and limited obstetric skills.[45,46] On the other hand, TBAs can be beneficial, especially if they are properly trained.[47,48] they need an appropriate support network to work effectively.[16]

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Methods

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Discussion

Conclusion