Payment for deliveries in Sierra Leone.

The type and amount of payment for deliveries were investigated in 1982 during a survey on health status in two districts. Data on the payments made for 83.5% of the 2591 deliveries in 535 randomly selected study villages showed that the most common method of payment was in cash only. Payments in kind were mostly given to trained traditional birth attendants (TBAs) (for 38.1% of their deliveries) and rare for professional staff (2.9% of deliveries). The total amount paid for a delivery differed significantly with the type of birth attendant (P less than 0.00001) and the place of delivery (hospital, peripheral health unit or home) (P less than 0.00001). The total average payment for a delivery was highest for professional birth attendants (Le 16.60) and lowest for untrained TBAs (Le 4.85) (Le 2 = approx. US+ 1 at the time of the study). The outcome of a delivery had a significant effect on the amount paid. Payments were significantly higher for stillbirths than for live births among professional and auxiliary birth attendants (P less than 0.0001). However, the trained and untrained TBAs received less payment for stillbirths (Le 2.25) than for live births (Le 4.89) (P = 0.0146). The results show that there are several levels of financial disincentives for pregnant women requiring the services of trained auxiliary or professional health workers at the time of delivery.