Cost of antenatal care for the health sector and for households in Rwanda

Abstract

BackgroundRwanda has made tremendous progress in reduction of maternal mortality in the last twenty years. Antenatal care is believed to have played a role in that progress. In late 2016, the World Health Organization published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other changes. There is ongoing debate regarding the cost implications and potential outcomes countries can expect, if they make that shift. For Rwanda, a necessary starting point is to understand the cost of current antenatal care practice, which, according to our knowledge, has not been documented so far.MethodsCost information was collected from Kigali City and Northern province of Rwanda through two cross-sectional surveys: a household-based survey among women who had delivered a year before the interview (N = 922) and a health facility survey in three public, two faith-based, and one private health facility. A micro costing approach was used to collect health facility data. Household costs included time and transport. Results are reported in 2015 USD.ResultsThe societal cost (household + health facility) of antenatal care for the four visits according to current Rwandan guidelines was estimated at $160 in the private health facility and $44 in public and faith-based health facilities. The first visit had the highest cost ($75 in private and $21 in public and faith-based health facilities) compared to the three other visits. Drugs and consumables were the main input category accounting for 54% of the total cost in the private health facility and for 73% in the public and faith-based health facilities.ConclusionsThe unit cost of providing antenatal care services is considerably lower in public than in private health facilities. The household cost represents a small proportion of the total, ranging between 3% and 7%; however, it is meaningful for low-income families. There is a need to do profound equity analysis regarding the accessibility and use of antenatal care services, and to consider ways to reduce households’ time cost as a possible barrier to the use of antenatal care.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3013-1) contains supplementary material, which is available to authorized users.

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.…”

“…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. 54 One study was conducted in an upper-middleincome country, South Africa.…”

“…With respect to the scale of the studies, eleven of the 36 studies were done at a sub-national scale, 25,27,30,31,41,47,49,50,52,53,57 four studies were conducted on a national scale, 28,29,32,34 while eight studies involved multiple facilities within one district. 35,[37][38][39][40]51,54,59 Thirteen studies were conducted within a single facility.…”

“…Seventeen studies were assessed as high quality. 25,26,30,34,36,37,40,42,44,46,47,[50][51][52]54,58,60 Fourteen studies were assessed to be of average quality. 29,[31][32][33]38,39,41,43,45,49,53,55,57,59 Five studies were judged to be of low quality.…”

The cost of maternal health services in low-income and middle-income countries from a provider’s perspective: a systematic review

“…Thus, 22 studies were included in our narrative review of which 15 provided disaggregated component cost for our analysis (figure 1). Nineteen of the included studies were retrieved from peer-review literature, [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] while the remaining three were sourced from grey literature. [46][47][48] distribution and quality assessment of included studies Thirteen studies were conducted in low-income countries (LICs) including four in Rwanda, 35 41 45 46 two each in Tanzania 32 36 and Uganda 29 34 and one each in Burkina Faso, 43 Democratic Republic of the Congo, 27 Ethiopia, 33 Haiti 48 and Somalia.…”