C Boukhalfa1, S Abouchadi1,2,3, N Cunden4, S Witter4. 1. Ecole Nationale de Santé Publique, Rabat, Morocco. 2. Université Libre de Bruxelles, Bruxelles, Belgium. 3. Institut of Tropical Medecine, Antwerp, Belgium. 4. University of Aberdeen, Aberdeen, UK.
Abstract
BACKGROUND: The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile. METHODS: Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units. RESULTS: Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites. CONCLUSION: The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes.
BACKGROUND: The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile. METHODS: Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units. RESULTS: Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites. CONCLUSION: The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes.
Authors: Geoffrey A Anderson; Lenka Ilcisin; Peter Kayima; Lenard Abesiga; Noralis Portal Benitez; Joseph Ngonzi; Mayanja Ronald; Mark G Shrime Journal: PLoS One Date: 2017-10-31 Impact factor: 3.240
Authors: Manraj Phull; Caris E Grimes; Thaim B Kamara; Haja Wurie; Andy J M Leather; Justine Davies Journal: BMJ Open Date: 2021-03-08 Impact factor: 2.692
Authors: Alex J van Duinen; Josien Westendorp; Thomas Ashley; Lars Hagander; Hampus Holmer; Alimamy P Koroma; Andrew J M Leather; Mark G Shrime; Arne Wibe; Håkon A Bolkan Journal: PLoS One Date: 2021-10-15 Impact factor: 3.240