Abstract
ObjectiveMonitoring essential health services coverage is important to inform resource allocation for the attainment of the Sustainable Development Goal 3. The objective was to assess service, effective and financial coverages of maternal healthcare services and their equity, using health and demographic surveillance site data in eastern Uganda.MethodsBetween Nov 2018 and Feb 2019, 638 resident women giving birth in 2017 were surveyed. Among them, 386 were randomly sampled in a follow-up survey (Feb 2019) on pregnancy and delivery payments and contents of care. Service coverage (antenatal care visits, skilled birth attendance, institutional delivery and one postnatal visit), effective coverage (antenatal and postnatal care content) and financial coverage (out-of-pocket payments for antenatal and delivery care and health insurance coverage) were measured, stratified by socio-economic status, education level and place of residence.ResultsCoverage of skilled birth attendance and institutional delivery was both high (88%), while coverage of postnatal visit was low (51%). Effective antenatal care was lower than effective postnatal care (38% vs 76%). Financial coverage was low: 91% of women made out-of-pocket payments for delivery services. Equity analysis showed coverage of institutional delivery was higher for wealthier and peri-urban women and these women made higher out-of-pocket payments. In contrast, coverage of a postnatal visit was higher for rural women and poorest women.ConclusionMaternal health coverage in eastern Uganda is not universal and particularly low for postnatal visit, effective antenatal care and financial coverage. Analysing healthcare payments and quality by healthcare provider sector is potential future research.
Highlights
Universal Health Coverage (UHC) has gained momentum as a key global health system goal, since the formulation in the world health assembly in 2005 (World Health Assembly, 2005, May 25)
UHC means that everyone has access to the quality healthcare services they need without suffering financial hardship and includes service coverage, financial coverage and population coverage (World Health Organization, 2010)
The data consisted of (1) census data on sociodemographic information, antenatal, intrapartum and postnatal service use from the latest two rounds conducted between April and July 2017 and November 2017 and May 2018 respectively, (2) data collected on financial coverage during an Sustainable Development Goals (SDG) survey (n = 5500 households) between November 2018 and February 2019, and (3) data collected on antenatal and postnatal services and out-of-pocket payments (n = 449 women) (Online Resource 1 and 2)
Summary
Universal Health Coverage (UHC) has gained momentum as a key global health system goal, since the formulation in the world health assembly in 2005 (World Health Assembly, 2005, May 25). It is included in the Sustainable Development Goals (SDG) Agenda outlined in target 3.8 (World Health Organization, 2019). Low-income countries have a disproportionately high burden of maternal mortality and UHC plays a key role in achieving the global target of reducing the maternal mortality ratio to less than 70 per 100,000 live births (World Health Organization, 2019, September). Addressing urban–rural and socio-economic inequities in coverage is essential to effectively reduce maternal mortality (Ruhago et al, 2012)
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