Abstract
BackgroundAs a result of financial barriers to the utilization of Maternal and Child Health (MCH) services, the Government of Sierra Leone launched the Free Health Care Initiative (FHCI) in 2010. This study aimed to examine the impact of the FHCI on wealth related inequity in the utilization of three MCH services.MethodsWe analysed data from 2008 to 2013 Sierra Leone Demographic Health Surveys (SLDHS) using 2008 SLDHS as a baseline. Seven thousand three hundred seventy-four and 16,658 women of reproductive age were interviewed in the 2008 and 2013 SLDHS respectively. We employed a binomial logistic regression to evaluate wealth related inequity in the utilization of institutional delivery. Concentration curves and indices were used to measure the inequity in the utilization of antenatal care (ANC) visits and postnatal care (PNC) reviews. Test of significance was performed for the difference in odds and concentration indexes obtained for the 2008 and 2013 SLDHS.ResultsThere was an overall improvement in the utilization of MCH services following the FHCI with a 30% increase in institutional delivery rate, 24% increment in more than four focused ANC visits and 33% increment in complete PNC reviews. Wealth related inequity in institutional delivery has increased but to the advantage of the rich, highly educated, and urban residents. Results of the inequity statistics demonstrate that PNC reviews were more equally distributed in 2008 than ANC visits, and, in 2013, the poorest respondents ranked by wealth index utilized more PNC reviews than their richest counterparts. For ANC visits, the change in concentration index was from 0.008331[95% CI (0.008188, 0.008474)] in 2008 to − 0.002263 [95% CI (− 0.002322, − 0.002204)] in 2013. The change in concentration index for PNC reviews was from − 0.001732 [95% CI (− 0.001746, − 0.001718)] in 2008 to − 0.001771 [95% CI (− 0.001779, − 0.001763)] in 2013. All changes were significant (p value < 0.001).ConclusionThe FHCI appears to be improving access to and utilization of MCH services, narrowing the inequity in ANC visits and PNC reviews, but is insufficient in addressing wealth- related inequity that exists for institutional deliveries. If Sierra Leone is to realize a significant reduction in maternal and child mortality rates, it needs to strengthen the effective implementation of FHCI considering incorporating a sector wide approach (SWAp) or a “Health in all Policy” framework to reach the less educated, rural residents and ensuring culturally sensitive quality services.
Highlights
As a result of financial barriers to the utilization of Maternal and Child Health (MCH) services, the Government of Sierra Leone launched the Free Health Care Initiative (FHCI) in 2010
For MCH utilization variables, we defined the number of antenatal visits (ANC) and post-natal reviews made (PNC) as discrete variables; we considered the number of visits to be complete if it reached the recommended number of visits as per the WHO guidelines [27, 28]
More than 50% of women attended the four ANC visits recommended by WHO focus antenatal care guideline in 2008, this number increased to 75% in 2013
Summary
As a result of financial barriers to the utilization of Maternal and Child Health (MCH) services, the Government of Sierra Leone launched the Free Health Care Initiative (FHCI) in 2010. Despite the gains in improving the health status of vulnerable segments of the society over the century, inequity in health and healthcare continue to persist globally [1] and obeying the inverse care law – the availability of good quality healthcare seems to be inversely related to the need for it [2] Such gap in health status between the rich and the poor is prevalent in many developing countries. In recognising the need to bridge the equity gap, most governments and international organisations have included key provisions in their primary healthcare delivery policy initiative to address such disparities [1, 3,4,5] Notwithstanding such commitments, the health status among the poor in sub- Saharan Africa is suboptimal [6].
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