Out-of-Pocket Expenditures for Delivery for Maternity Waiting Home Users and Non-users in Rural Zambia.

Constance P Fontanet,Isaac Sakala,Nancy A Scott,Thandiwe Ngoma,Taryn Vian,Davidson H Hamer,Jody R Lori,Jeanette L Kaiser,Godfrey Biemba,Rachel M Fong,Peter C Rockers,Kathleen Lucile Mcglasson,Michelle Munro-Kramer

doi:10.34172/ijhpm.2021.61

Abstract

Utilizing maternity waiting homes (MWHs) is a strategy to improve access to skilled obstetric care in rural Zambia. However, out-of-pocket (OOP) expenses remain a barrier for many women. We assessed delivery-related expenditure for women who used MWHs and those who did not who delivered at a rural health facility. During the endline of an impact evaluation for an MWH intervention, household surveys (n = 826) were conducted with women who delivered a baby in the previous 13 months at a rural health facility and lived >10 km from a health facility in seven districts of rural Zambia. We captured the amount women reported spending on delivery. We compared OOP spending between women who used MWHs and those who did not. Amounts were converted from Zambian kwacha (ZMW) to US dollar (USD). After controlling for confounders, there was no significant difference in delivery-related expenditure between women who used MWHs (US$40.01) and those who did not (US$36.66) (P=.06). Both groups reported baby clothes as the largest expenditure. MWH users reported spending slightly more on accommodation compared to those did not use MWHs, but this difference represents only a fraction of total costs associated with delivery. Findings suggest that for women coming from far away, utilizing MWHs while awaiting delivery is not costlier overall than for women who deliver at a health facility but do not utilize a MWH.

Highlights

In rural Zambia, women who use maternity waiting home (MWH) before giving birth at a facility do not spend more on delivery-associated expenditure compared to women who do not choose to stay in a MWH
Our findings suggest that, for women living most remotely who deliver at rural health facilities in Zambia, using a MWH does not cost significantly more than delivering at a rural health facility without using a MWH when considering key categories of common delivery-related expenses
We found that staying at a MWH was not associated with higher delivery-associated OOP costs

Summary

Introduction

Fontanet et al user fees for facility-based delivery services, including delivery.[10] In 2006, the Zambian government abolished user fees, including those for maternal health services, as part of a similar national effort to increase access to healthcare facilities.[11] While this policy reduced expenditure for service users, there is mixed evidence regarding the impact of user fee removal on facility-based delivery rates.[11,12] user-fee elimination has not removed all financial barriers. Women across Zambia, Tanzania, and Ethiopia continue to face other financial roadblocks including OOP expenditure for transportation to health facilities, delivery supplies, and baby clothes.[5,7,8,9,13,14,15,16]

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Results

Conclusion