The Effect of Demand- and Supply-Side Health Financing on Infant, Child, and Maternal Mortality in Low- and Middle-Income Countries

Abstract

Demand-and supply-side health financing programs that improve maternal and child health are being implemented more frequently; however, there is limited evidence estimating their impact on maternal, infant, and child mortality at the macro level. The purpose of the study was to determine the impact of four specific types of demand-and supply-side health financing programs on infant, child, and maternal mortality at the global level and by county income categories. The following four demand-and supply-side health financing programs were chosen for inclusion in the analysis: conditional cash transfer programs, voucher programs, community-based health insurance, and pay-for-performance schemes. A fixed effects model was estimated, using panel data for 147 countries over the period 1995-2010, to measure the impact of these four demand-and supply-side health financing programs on infant, under-five, and maternal mortality. The model was estimated for all countries and for three country income categories: low, lower-middle, and upper-middle income. The implementation of demand-and supply-side health financing programs has increased over time, with 45 out of 147 countries in the data set implementing at least one of these programs by 2010. The results show that there is a significant decline in infant and under-five mortality from community-based health insurance when examined across all countries. There is also an impact from demand-and supply-side health financing when examined across the three country income classifications, with vouchers and pay-for-performance showing a varying impact on reduced infant, under-five, and maternal mortality depending on the country income classification. Health insurance schemes with a broad population reach, such as community-based health insurance, can have a large impact on infant and under-five mortality. Demand-and supplyside health financing programs, such as pay-for-performance and voucher programs, have a varying impact on infant, under-five, and maternal mortality depending on the income level of the country.

Improving the effective maternal-child health care coverage through synergies between supply and demand-side interventions: evidence from Mexico

“…Examples of the former are the delivery of coupons, subsidies and conditional cash transfers (CCT) that promote changes in risk behaviors in the target population and incentives for the use of health services. Health insurance schemes for larger population groups and pay-for-performance programs for health providers are examples of interventions on the supply side [8][9][10].…”

“…Previous studies have documented the effects of supply and demand-side interventions and showed an increase in the use of health care services and in the reduction of child mortality, mortality among children 5 years of age and under and maternal mortality [8,9]. However, they highlight to pay special attention to the organizational, logistic, and administrative aspects from the supply side of health services.…”

Cost of Delivering Secondary Healthcare Through the Public Sector in India

“…Traditionally, health systems across developing countries, including India, have been financed through supply-side financing mechanisms [4,5]. With the launch of a supplyside initiative in the form of the National Rural Health Mission (NRHM) in 2005, a large volume of resources was spent on the creation of new CHCs (65% increase in the number of CHCs) and strengthening old ones (15-60% increase in the number of staff) across India during the period of 2005-2016 [6,7].…”

Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation

“…Demand side financing, or strategies to incentivise the use of specific services by reducing financial barriers to care seeking (Bowser, Gupta, & Nandakumar, 2016), include selective removal of user fees (McKinnon, Harper, Kaufman, & Bergevin, 2015), the distribution of vouchers (Bhatia & Gorter, 2007), conditional cash transfers (Lagarde, Haines, & Palmer, 2007) and health insurance (Morgan et al, 2013). Voucher schemes and health insurance can increase patient choice by removing financial barriers to care seeking, whilst also potentially incentivising providers to deliver better quality care (Grainger, Gorter, Okal, & Bellows, 2014).…”