Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka

Gunarathna, Sajan Praveena; Wickramasinghe, Nuwan Darshana; Agampodi, Thilini Chanchala; Prasanna, Indika Ruwan; Agampodi, Suneth Buddhika

doi:10.9745/ghsp-d-22-00410

Glob Health Sci Pract

2023

DOI: 10.9745/ghsp-d-22-00410

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Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka

Sajan Praveena Gunarathna,

Nuwan Darshana Wickramasinghe,

Thilini Chanchala Agampodi

et al.

Abstract: The authors report that even with the free health care services provided by the government, out-of-pocket expenditure for antenatal care in Sri Lanka is high, and women in low-income groups have a higher expenditure compared to higher-income groups.

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2024

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Cited by 2 publications

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Assessment of the productivity loss due to leading maternal ill-health conditions: a follow-up study of a prospective pregnancy cohort in rural Sri Lanka

Gunarathna,

Wickramasinghe,

Agampodi

et al. 2024

BMJ Open

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ObjectivesThis study aimed to assess the productivity loss and cost due to maternal ill-health conditions and its associated factors throughout pregnancy in rural Sri Lanka.DesignA follow-up study of women registered in the Rajarata Pregnancy Cohort (RaPCo).SettingAnuradhapura district, Sri Lanka.Participants1573 pregnant women who were followed up from pregnancy identification to termination.Primary and secondary outcome measuresThe primary outcome measures of this study are productivity loss due to maternal ill-health conditions expressed by days/month and productivity cost due to maternal ill-health conditions expressed in monetary terms (US$)/month. Data were collected monthly, and all pregnant women were asked to report the leading cause of maternal ill-health condition and the associated loss due to absenteeism and presenteeism.ResultsDuring the pregnancy follow-up, 3595 (81.5%) months had at least one episode of maternal ill-health condition. Of these, only 1729 (48.1%) episodes sought medical care. Assistance for lost routine work was reported in 1281 (35.6%) episodes. The absenteeism, presenteeism and gross and net productivity loss per month were 3.6, 4.5, 8.1 and 5.5 days/month, respectively. The corresponding productivity cost was US$15.26/month. Nausea and vomiting (NVP) reported the highest prevalence (n=1599, 44.5%) until the second month of the third trimester, presenteeism (5.5 days/month) and gross productivity loss (9.5 days/month). Pregnant women with vaginal bleeding reported the highest absenteeism (6.2 days/month) and net productivity loss (6.8 days/month). Pregnant women diagnosed with anaemia reported the highest productivity cost (US$26.98/month). Monthly household expenditure, poverty and receiving assistance were the associated factors of productivity loss (p<0.05).ConclusionMaternal ill-health conditions during pregnancy lead to productivity loss in rural Sri Lanka. NVP, vaginal bleeding and anaemia are the leading causes of productivity loss. Hence, controlling and preventing the leading causes are the recommended priorities.

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Assessment of the productivity loss due to leading maternal ill-health conditions: a follow-up study of a prospective pregnancy cohort in rural Sri Lanka

Gunarathna,

Wickramasinghe,

Agampodi

et al. 2024

BMJ Open

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Financing for equity for women’s, children’s and adolescents’ health in low- and middle-income countries: A scoping review

Bou-Karroum,

Iaia,

El-Jardali

et al. 2024

PLOS Glob Public Health

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Over the past few decades, the world has witnessed considerable progress in women’s, children’s and adolescents’ health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs). This scoping review was conducted following Joanna Briggs Institute (JBI) guidance for conducting such reviews as well as the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for reporting scoping reviews. We searched Medline, PubMed, EMBASE and the World Health Organization’s (WHO) Global Index Medicus, and relevant websites. The selection process was conducted in duplicate and independently. Out of 26 355 citations identified from electronic databases, relevant website searches and stakeholders’ consultations, 413 studies were included in the final review. Conditional cash transfers (CCTs) (22.3%), health insurance (21.4%), user fee exemptions (18.1%) and vouchers (16.9%) were the most reported financial interventions and measures. The majority were targeted at women (57%) and children (21%) with others targeting adolescents (2.7%) and newborns (0.7%). The findings highlighted that CCTs, voucher programs and various insurance schemes can improve the utilization of maternal and child health services for the poor and the disadvantaged, and improve mortality and morbidity rates. However, multiple implementation challenges impact the effectiveness of these programmes. Some studies suggested that financial interventions alone would not be sufficient to achieve equity in health coverage among those of a lower income and those residing in remote regions. This review provides evidence on financing interventions to address the health needs of the most vulnerable communities. It can be used to inform the design of equitable health financing policies and health system reform efforts that are essential to moving towards universal health coverage (UHC). By also unveiling the knowledge gaps, it can be used to inform future research on financing interventions and measures to improve equity when addressing WCAH in LMICs.

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Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka

Abstract: The authors report that even with the free health care services provided by the government, out-of-pocket expenditure for antenatal care in Sri Lanka is high, and women in low-income groups have a higher expenditure compared to higher-income groups.

Cited by 2 publications

References 58 publications

Assessment of the productivity loss due to leading maternal ill-health conditions: a follow-up study of a prospective pregnancy cohort in rural Sri Lanka

Assessment of the productivity loss due to leading maternal ill-health conditions: a follow-up study of a prospective pregnancy cohort in rural Sri Lanka

Financing for equity for women’s, children’s and adolescents’ health in low- and middle-income countries: A scoping review

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