What it costs to access skilled birth attendance in Pakistan

Abstract

Background: A costing study was conducted as part of a randomized controlled trial on promoting safe birthing, among 60,000 pregnancies in Punjab. This costing study aimed to estimate the costs incurred by women for utilisation of skilled birth attendance. Methods: 640 women were recruited from six public health clusters in two districts of Pakistan. Costs were calculated using the societal perspective where the costs incurred on enhancing birth skilled attendance by delivering birth planning intervention were calculated from both the client and health service provider perspective. Province wise projection of costs were also calculated for two years’ time duration. Results: Health services capital cost for enhancing utilization of skilled birth attendance was Rs: 801 (US$ 8) per LHW and the recurrent per pregnant woman was Rs. 4.8 (US$ 0.05). Client cost of skilled birth utilization for normal delivery ranged from 3564(US$ 35.64) at a public facility vs 5276 (US$ 52.76) at a private facility, while for caesarean delivery it ranged from 10383 (US$ 103.83) at a public facility to 14339 (US$ 143.39) at a private facility. Cost of normal delivery was found to be correlated with category of birth attendant. Personal savings and loans were two main modes of payment for child birthing. In Punjab the incremental investment of Rs 67.7 million (US$ 677000) can achieve 675,971 additional deliveries by skilled birth attendants. Conclusion: The birth planning intervention was found to be cost-effective in enhancing skilled birth attendance rate as compared to the control arm. Keywords: Skilled birth attendance, health services cost, out of pocket cost, normal delivery, caesarean delivery