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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.

Suggested Citation

  • 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. Celik, Yusuf & Hotchkiss, David R., 2000. "The socio-economic determinants of maternal health care utilization in Turkey," Social Science & Medicine, Elsevier, vol. 50(12), pages 1797-1806, June.
    2. Starfield, Barbara, 2007. "Pathways of influence on equity in health: A rejoinder to Braveman and Wilkinson," Social Science & Medicine, Elsevier, vol. 64(7), pages 1371-1372, April.
    3. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
    4. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    5. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    6. Starfield, Barbara, 2007. "Pathways of influence on equity in health," Social Science & Medicine, Elsevier, vol. 64(7), pages 1355-1362, April.
    7. Deon Filmer & Lant Pritchett, 1999. "The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries," Population and Development Review, The Population Council, Inc., vol. 25(1), pages 85-120, March.
    8. Brazier, Ellen & Andrzejewski, Catherine & Perkins, Margaret E. & Themmen, Ellen M. & Knight, Rodney J. & Bassane, Brahima, 2009. "Improving poor women's access to maternity care: Findings from a primary care intervention in Burkina Faso," Social Science & Medicine, Elsevier, vol. 69(5), pages 682-690, September.
    9. Lu, Jui-fen R. & Leung, Gabriel M. & Kwon, Soonman & Tin, Keith Y.K. & Van Doorslaer, Eddy & O'Donnell, Owen, 2007. "Horizontal equity in health care utilization evidence from three high-income Asian economies," Social Science & Medicine, Elsevier, vol. 64(1), pages 199-212, January.
    10. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    11. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    12. Adam Wagstaff & Naoko Watanabe, 2003. "What difference does the choice of SES make in health inequality measurement?," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 885-890, October.
    13. M. R. Bhatia & A. C. Gorter, 2007. "Improving access to reproductive and child health services in developing countries: are competitive voucher schemes an option?," Journal of International Development, John Wiley & Sons, Ltd., vol. 19(7), pages 975-981.
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