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Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh

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  • Ahmed, Shakil
  • Khan, M. Mahmud

Abstract

Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6Â times more likely to be assisted by skilled health personnel during delivery, 2.5Â times more likely to deliver the baby in a health facility, 2.8Â times more likely to receive postnatal care (PNC), 2.0Â times more likely to get antenatal care (ANC) services and 1.5Â times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3Â times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor developing countries.

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  • Ahmed, Shakil & Khan, M. Mahmud, 2011. "Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh," Social Science & Medicine, Elsevier, vol. 72(10), pages 1704-1710, May.
    • Handle: RePEc:eee:socmed:v:72:y:2011:i:10:p:1704-1710
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    1. Muhammad Badiuzzaman & Syed Mansoob Murshed, 2016. "Impact of post-conflict development interventions on maternal healthcare utilization," WIDER Working Paper Series 082, World Institute for Development Economic Research (UNU-WIDER).
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    3. Sayedur Rahman & Aziz Ahmed Choudhury & Rasheda Khanam & Syed Mamun Ibne Moin & Salahuddin Ahmed & Nazma Begum & Nurun Naher Shoma & Md Abdul Quaiyum & Abdullah H Baqui & for the Projahnmo Study Group, 2017. "Effect of a package of integrated demand- and supply-side interventions on facility delivery rates in rural Bangladesh: Implications for large-scale programs," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-13, October.
    4. Witvorapong, Nopphol & Foshanji, Abo Ismael, 2016. "The impact of a conditional cash transfer program on the utilization of non-targeted services: Evidence from Afghanistan," Social Science & Medicine, Elsevier, vol. 152(C), pages 87-95.
    5. Chatterjee, Somdeep & Poddar, Prashant, 2019. "Maternal Health, Children Education and Women Empowerment: Quasi-Experimental Evidence from India," GLO Discussion Paper Series 332, Global Labor Organization (GLO).
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    11. Tazeen Tahsina & Nazia Binte Ali & Md Abu Bakkar Siddique & Sameen Ahmed & Mubashshira Rahman & Sajia Islam & Md Mezanur Rahman & Bushra Amena & D M Emdadul Hoque & Tanvir M Huda & Shams El Arifeen, 2018. "Determinants of hardship financing in coping with out of pocket payment for care seeking of under five children in selected rural areas of Bangladesh," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-17, May.
    12. Rahman, Mohammad Mahbubur & Pallikadavath, Saseendran, 2018. "How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India," Economics & Human Biology, Elsevier, vol. 31(C), pages 164-183.
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    16. Tulasi Malini Maharatha & Sumirtha Gandhi & Umakant Dash, 2021. "Has the Demand and Supply-side Components of Janani Suraksha Yojana Augmented the Uptake of Maternal Health Care Services among Poor Women in India ? : An Application of Hybrid Matching Technique," BASE University Working Papers 08/2021, BASE University, Bengaluru, India.
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    18. Randive, Bharat & San Sebastian, Miguel & De Costa, Ayesha & Lindholm, Lars, 2014. "Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: Results from nine states in India," Social Science & Medicine, Elsevier, vol. 123(C), pages 1-6.
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    20. Mats Målqvist & Beibei Yuan & Nadja Trygg & Katarina Selling & Sarah Thomsen, 2013. "Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-10, June.
    21. Annear, Peter Leslie & Ahmed, Shakil & Ros, Chhun Eang & Ir, Por, 2013. "Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: A study of policy barriers and opportunities in Cambodia," Social Science & Medicine, Elsevier, vol. 96(C), pages 223-231.
    22. Muhammad Badiuzzaman & Syed Mansoob Murshed, 2016. "Impact of post-conflict development interventions on maternal healthcare utilization," WIDER Working Paper Series wp-2016-82, World Institute for Development Economic Research (UNU-WIDER).

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