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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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    Cited by:

    1. Coffey, Diane, 2014. "Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India," Social Science & Medicine, Elsevier, pages 89-96.
    2. Kim, Chang-O & Joung, Won Oh, 2014. "Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study," Social Science & Medicine, Elsevier, pages 28-35.
    3. Zafer Çalışkan & Dilek Kılıç & Selcen Öztürk & Emre Atılgan, 2015. "Equity in maternal health care service utilization: a systematic review for developing countries," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), pages 815-825.
    4. Pulok, Mohammad Habibullah & Sabah, Md Nasim-Us Sabah & Uddin, Jalal & Enemark, Ulrika, 2015. "Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?," MPRA Paper 63496, University Library of Munich, Germany.
    5. 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, pages 1-6.
    6. 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, pages 87-95.
    7. Asian Development Bank (ADB), 2012. "Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity in Bangladesh: Out-of-Pocket Payments by Patients at Ministry of Health and Family Welfare Facilities in Bangladesh and ," ADB Reports RPT135432-3, Asian Development Bank (ADB), revised 02 Sep 2013.
    8. 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, pages 223-231.
    9. Ahmed Shoukry Rashad & Mesbah Fathy Sharaf, 2016. "Socio-Economic Inequalities in Maternity Care Under Political Instability: Evidence from Egypt, Jordan and Yemen," Working Papers 1011, Economic Research Forum, revised Jun 2016.
    10. Kamiya, Yusuke & Yoshimura, Yukie & Islam, Mohammad Tajul, 2013. "An impact evaluation of the Safe Motherhood Promotion Project in Bangladesh: Evidence from Japanese aid-funded technical cooperation," Social Science & Medicine, Elsevier, pages 34-41.

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