Economic consequences of caesarean section delivery: evidence from a household survey in Tanzania

Peter Binyaruka,Amani Thomas Mori

doi:10.1186/s12913-021-07386-0

Peter Binyaruka, Amani Thomas Mori

Open Access

https://doi.org/10.1186/s12913-021-07386-0

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Abstract

BackgroundCaesarean section (C-section) delivery is an important indicator of access to life-saving essential obstetric care. Yet, there is limited understanding of the costs of utilising C-section delivery care in sub-Saharan Africa. Thus, we estimated the direct and indirect patient cost of accessing C-section in Tanzania.MethodsCross-sectional survey data of 2012 was used, which covered 3000 households from 11 districts in three regions. We interviewed women who had given births in the last 12 months before the survey to capture their experience of care. We used a regression model to estimate the effect of C-section on costs, while the degree of inequality on C-section coverage was assessed with a concentration index.ResultsC-section increased the likelihood of paying for health care by 16% compared to normal delivery. The additional cost of C-section compared to normal delivery was 20 USD, but reduced to about 11 USD when restricted to public facilities. Women with C-section delivery spent an extra 2 days at the health facility compared to normal delivery, but this was reduced slightly to 1.9 days in public facilities. The distribution of C-section coverage was significantly in favour of wealthier than poorest women (CI = 0.2052, p < 0.01), and this pro-rich pattern was consistent in rural districts but with unclear pattern in urban districts.ConclusionsC-section is a life-saving intervention but is associated with significant economic burden especially among the poor families. More health resources are needed for provision of free maternal care, reduce inequality in access and improve birth outcomes in Tanzania.

Highlights

Caesarean section (C-section) delivery is an important indicator of access to life-saving essential obstetric care
We provided the evidence on the estimates of both direct (OOP payments) and indirect cost of C-section and normal delivery care in the context of free maternal health care in Tanzania
Out of 2874 women, 86% (n = 2466) had facility-based delivery care, 78% (n = 2229) had normal delivery and 8% (n = 237) had C-section delivery (7.5% of C-section were in public facilities only)

Summary

Introduction

Caesarean section (C-section) delivery is an important indicator of access to life-saving essential obstetric care. The UHC goal ensures that everyone has access to good quality health care without incurring financial hardship due to health care payment [2]. The chances of incurring economic costs depend on many factors like the opportunity of accessing care, the existence of health financing policies which can ensure financial risk protection, and the nature of the illness. Evidence shows that the direct financial costs are major barriers to access health care, which disincentive people to seek care [11,12,13]. The health financing system which relies on OOP payments as opposed to prepayment mechanisms (e.g., tax funding and health insurance) often expose a large population, especially the low-income populations, into financial hardship due to medical spending [6, 14]. The nature of illness influences patients to incur economic costs –e.g., maternal obstetric complications are often unplanned and associated with large financial costs and productivity loss due to hospitalisation [8, 21, 22]

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