Are Free Maternity Services Completely Free of Costs?

Abstract

ObjectivesThe Government of Nepal revised free maternity health services, “Aama Surakshya Karyakram”, beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services.MethodsBetween August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire.ResultsThe average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2−19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively.ConclusionThe free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during the hospital stay and at discharge time. Similarly, arrangements for liquid, food, and hot water, as well as clothes for mothers and newborns, should be made by the hospital in order to enhance hospital attendance.

Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review

“…Ten studies were published between 2000 and 2010 25,27,28,38,39,41,48,[51][52][53] while the remaining 26 were published post-2010. 26,[29][30][31][32][33][34][35][36][37]40,[42][43][44][45][46][47]49,50,[54][55][56][57][58][59][60] Figure 2 shows the geographical distribution of LMICs having at least one published study on the cost of maternal health service utilisation. Fifteen lowincome countries have published costing studies focused on maternal health service utilisation.…”

“…Fifteen lowincome countries have published costing studies focused on maternal health service utilisation. This includes three each in Nepal 42,46,53 and Tanzania, 37,41,52 two each in Ethiopia 32,55 and Mali, 40,57 and one each in Benin, 51 Burkina Faso, 38 Madagascar, 43 Pakistan, 36 and Rwanda. 50 Twenty lowermiddle income countries have published costing studies including nine studies published on India, 25,[28][29][30]33,34,47,48,56 four studies in Nigeria, 27,45,49,59 two each in Bangladesh, 31,39 and Zambia, 58,60 and one each in Ghana, 51 Kenya, 41 Lao PDR, 44 and Morocco.…”

“…In all, twenty-two studies reported costs of utilising skilled birth attendance for normal vaginal delivery 25,[28][29][30][32][33][34]36,38,39,41,42,[44][45][46][47][48][49][51][52][53]56 and another two assessed cost associated with using assisted vaginal delivery. 32,59 Fourteen studies estimated cost of utilising skilled birth attendance during caesarean delivery 25,31,32,36,39,[42][43][44]48,49,53,54,56 while ten studies focused on cost of ANC utilisation. 25,28,30,31,35,37,47,49,51,59 Five studies focused on cost of utilising PNC 25,28,…”

The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana

“…However, studies in Africa and Asia have shown that OOP payments still persisted in the midst of fee exemptions policies, especially for skilled attendance at childbirth [ 11 , 20 – 25 ]. This phenomenon is attributed to systemic challenges [ 14 ].…”

Study of Rational and Irrational Prescribing in Different Government and Private Health Care Centres of Punjab

“…From each city we took 50 patients from clinics and 50 from government hospitals. If we see results on the basis of rational and irrational [21][22][23][24][25] then see that rational prescribing was 48, 41, 45 and 43 in Gujranwala, Okara and Wazirabad and in Hafiz Abad respectively and irrational prescribing was 52, 59, 55 and 57 in Gujranwala, Okara and Wazirabad and in Hafiz Abad respectively (Table 2).…”