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Feasibility of demand-side financing in maternal health-care services in rural Bangladesh

Date: Poster sessions
Source: Forum 11
Authors: Azaher Molla, Assistant Professor, Institute of Health Economics, Health Economics, University of Dhaka, Bangladesh
with SR Howlader, A Rahman and A Mustafa


In Bangladesh, about 92% of births are still delivered at home and skilled birth attendants attend only 13% of births. About 69% of poor households do not have access to any antenatal care (ANC) compared to 22% of the richest quintile. It is hypothesized that various demand-side factors contribute in reducing access of the poor to maternal health care.

The purpose of this study was to look at the feasibility of the demand-side financing (DSF) scheme among rural poor mothers by collecting information on demand- side factors of maternal health care and also to assess the purchasing capacity and communities' behaviour towards introducing the DSF scheme.

Primary data were collected from pregnant mothers and mothers in the postnatal period. Key informant interviews (KII) were conducted with community and religious leaders, and public representatives. Population representative samples were collected from six areas, from 450 pregnant women and women in the neonatal period.

The rate of utilization of ANC was 32.2%, postnatal care (PNC) was 14.3%, and deliveries assisted by medically competent persons were 10.5%. The average cost of ANC was Tk.68.75 (US$ 1), PNC Tk.41.25 (US$ 0.60) and delivery Tk.650 (about US$ 10). The majority of families met the cost of delivery from savings (29.5%), followed by personal loans (4.5%) and the sale of household goods or assets such as cows, goats, trees or ornaments (50%).

Findings suggest that introducing a pre-paid voucher scheme would increase utilization of maternal health care, empower people to make choices among different providers, increase quality of care or supply of goods, make providers responsive to users, and provide financial protection in the event of major illness. Considering the economic status of the households with the pregnant mothers some prepaid voucher scheme may be introduced. The proposed voucher could be introduced on a sliding scale. Targeting the poor and choosing beneficiaries needs to be a careful exercise for a developing country like Bangladesh.