Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho

Abstract

Objective Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co‐payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho. Methods We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives. Results Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% — from 1547 to 2308 — and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital. Conclusion Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries.

The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

“…In this perspective, fees of 12-30 USD are considerable and a great burden to the family economy. Previous studies from various sub-Saharan countries could show that the removal of delivery fees resulted in an increase of facility-based deliveries, and a study from Lesotho showed that the removal of ambulance and delivery fees resulted as well in a decrease in neonatal and maternal mortality rates (16)(17)(18)(19)(20). The ndings of this study implicate that an excess of about 80 CSs per 1000 births as a consequence of user fees might have been avoided by more timely birth attendance.…”

User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study

“…This is in line with a finding from Lesotho which reported that pregnancy-related complications doubled the MHSU in higher hospitals. 26 Women with identified and known complications related to their pregnancy might have good health-seeking behavior to mitigate risk. Similarly, the odds of adherence to MHSU were higher among women having primary/secondary and above educational background than their counterparts.…”

The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

“…In this perspective, fees of 12–30 USD are considerable and a great burden to the family economy. Previous studies from various sub-Saharan countries could show that the removal of delivery fees resulted in an increase of facility-based deliveries, and a study from Lesotho showed that the removal of ambulance and delivery fees resulted as well in a decrease in neonatal and maternal mortality rates [ 16 – 20 ]. The findings of this study implicate that an excess of about 80 CSs per 1000 births as a consequence of user fees might have been avoided by more timely birth attendance.…”