OBJECTIVE: To identify the main drivers of costs of facility delivery and the financial consequences for households among rural women in Tanzania, a country with a policy of delivery fee exemptions. METHODS: We selected a representative sample of households in a rural district in western Tanzania. Women who given birth within 5 years were asked about payments for doctor's/nurse's fees, drugs, non-medical supplies, medical tests, maternity waiting home, transport and other expenses. Wealth was assessed using a household asset index. We estimated the proportion of women who cut down on spending or borrowed money/sold household items to pay for delivery in each wealth group. RESULTS: In all, 73.3% of women with facility delivery reported having made out-of-pocket payments for delivery-related costs. The average cost was 6272 Tanzanian shillings (TZS), [95% Confidence Interval (CI): 4916, 7628] or 5.0 United States dollars. Transport costs (53.6%) and provider fees (26.6%) were the largest cost components in government facilities. Deliveries in mission facilities were twice as expensive as those in government facilities. Nearly half (48.3%) of women reported cutting down on spending or borrowing money/selling household assets to pay for delivery, with the poor reporting this most frequently. CONCLUSION: Out-of-pocket payments for facility delivery were substantial and were driven by high transport costs, unofficial provider payments, and preference for mission facilities, which levy user charges. Novel approaches to financing maternal health services, such as subsidies for transport and care from private providers, are required to reduce the cost barriers to attended delivery.
OBJECTIVE: To identify the main drivers of costs of facility delivery and the financial consequences for households among rural women in Tanzania, a country with a policy of delivery fee exemptions. METHODS: We selected a representative sample of households in a rural district in western Tanzania. Women who given birth within 5 years were asked about payments for doctor's/nurse's fees, drugs, non-medical supplies, medical tests, maternity waiting home, transport and other expenses. Wealth was assessed using a household asset index. We estimated the proportion of women who cut down on spending or borrowed money/sold household items to pay for delivery in each wealth group. RESULTS: In all, 73.3% of women with facility delivery reported having made out-of-pocket payments for delivery-related costs. The average cost was 6272 Tanzanian shillings (TZS), [95% Confidence Interval (CI): 4916, 7628] or 5.0 United States dollars. Transport costs (53.6%) and provider fees (26.6%) were the largest cost components in government facilities. Deliveries in mission facilities were twice as expensive as those in government facilities. Nearly half (48.3%) of women reported cutting down on spending or borrowing money/selling household assets to pay for delivery, with the poor reporting this most frequently. CONCLUSION: Out-of-pocket payments for facility delivery were substantial and were driven by high transport costs, unofficial provider payments, and preference for mission facilities, which levy user charges. Novel approaches to financing maternal health services, such as subsidies for transport and care from private providers, are required to reduce the cost barriers to attended delivery.
Authors: Margaret E Kruk; Sabrina Hermosilla; Elysia Larson; Daniel Vail; Qixuan Chen; Festo Mazuguni; Beatrice Byalugaba; Godfrey Mbaruku Journal: Trop Med Int Health Date: 2015-04-30 Impact factor: 2.622
Authors: Margaret E Kruk; Anna D Gage; Catherine Arsenault; Keely Jordan; Hannah H Leslie; Sanam Roder-DeWan; Olusoji Adeyi; Pierre Barker; Bernadette Daelmans; Svetlana V Doubova; Mike English; Ezequiel García-Elorrio; Frederico Guanais; Oye Gureje; Lisa R Hirschhorn; Lixin Jiang; Edward Kelley; Ephrem Tekle Lemango; Jerker Liljestrand; Address Malata; Tanya Marchant; Malebona Precious Matsoso; John G Meara; Manoj Mohanan; Youssoupha Ndiaye; Ole F Norheim; K Srinath Reddy; Alexander K Rowe; Joshua A Salomon; Gagan Thapa; Nana A Y Twum-Danso; Muhammad Pate Journal: Lancet Glob Health Date: 2018-09-05 Impact factor: 26.763
Authors: Cheryl A Moyer; Philip B Adongo; Raymond A Aborigo; Abraham Hodgson; Cyril M Engmann; Raymond DeVries Journal: Matern Child Health J Date: 2014-01
Authors: Maike Tipke; Valérie R Louis; Maurice Yé; Manuela De Allegri; Claudia Beiersmann; Ali Sié; Olaf Mueller; Albrecht Jahn Journal: Malar J Date: 2009-11-24 Impact factor: 2.979