Subsidizing Maternal Health Services Costs To Improve Utilization Dr. Haris Ahmed, MPH, FRSPH Deputy Director
Pakistan’s Maternal Health Status • Population – 167 million • Adult female literacy – 30% • Women of reproductive age – approx. 43 million • Coverage along continuum of care CPR (Modern Method) 22 Antenatal coverage 61 Births conducted by skilled personals Post-natal care Pakistan Demographic and Health Survey 2006 -2007 39 33
Pakistan – Maternal Health Indicators • Maternal mortality ratio – 276/100, 000 live births – Punjab – 227 ; Baluchistan – 785 – Urban – 175 ; Rural – 319 – 15, 000 to 20, 000 deaths / year • Children under 5 mortality rate 94/1, 000 live births – 300, 000 child deaths / year Pakistan Demographic and Health Survey 2006 -2007
Health Care Delivery System Pakistan Demographic and Health Survey 2006 -07 70% Private Health Care Providers Secretariat Directorate 57% Unnecessary 38% Costly Unskilled Birth Attendants 47% Cost of treatment for complications not bearable 60% Deliveries
A Demand Side Strategy • Cost of services – A critically important element that determines the opportunity to access maternal health services • Utilizing trained providers – partially successful if social and psychological costs are lowered • Demand side strategy – lowers the “monetary” cost of services to households
“Voucher for Health” A small scale pilot project To improve access and utilization of services a one year “Voucher for Health ” pilot was launched in in six Union Councils of DG Khan city of Punjab.
Methodology • Twenty private sector providers • Beneficiaries – 1, 999 pregnant women – 2 nd or 3 rd trimester – Average monthly household income < US$ 80. 00 – History of home-based deliveries by a TBA First Pregnancy 26% Skilled Provider 13% Shopkeeper 9% Skilled Worker 9% Private Worker 9% Unemployed 8% Who conducted last Unskilled Provider delivery 61% Husband’s Occupation Laborer 65%
Voucher for Health US$ 1. 20
VS Services Against Each Voucher Services Against Each. Services Voucher Activity Providers 1. 1 st AN Checkup • ANC (fill the ANC Card) • Medicines – Iron Tab, Anti Emetics, Analgesics & M/Vitamin • TT Injection 2. 2 nd AN Checkup • ANC (fill the ANC Card) • Medicines – Iron Tab, Anti Emetics, Analgesics & M/Vitamin 3. 3 rd AN Checkup • ANC (fill the ANC Card) • Medicines – Iron Tab, Anti Emetics, Analgesics & M/Vitamin • TT Injection 4. Lab Investigation • Blood CP – Blood Group – Urine RE – Blood HBs – Blood HCV 5. Ultra Sonography • Ultra Sonography 6. Normal Delivery • SVD with Medicines (fill the ANC Card) 7. Cesarean Section • Cesarean Section with medicines 8. PN Checkup 9. FP Counseling • • PNC (fill the ANC Card) Medicines – Analgesics and M/Vitamin FP Counseling FP Services (products i. e. Injections, Pills or IUD)
Quality Assurance • Client counseling • Random visits by the field team • Each provider was only reimbursed after physical verification of each returned voucher Client Counselling Cards
Results Vouchers Redeemed 95% Antenatal Care 92% Lab Investigations 67% Ultrasonograpgy 84% Tetanus Immunization 86% Facility Based Deliveries Caesarean Section 96% 13% Postnatal Care 87% FP Consultation 94% IUD Use Tubal Ligation 48% 9%
Concluding Thoughts • Increased use of health services • Engage private sector PROMISE WELL KEPT • Improved quality of service • Increased awareness of HTSP • Sustainability Cost should not be a consideration in light of benefits An emergency cesarean section, performed under the “Voucher for Health” initiative, saved the life of Tasleem and her baby boy – March 09, 2009.
Pathfinder International House 579, Street 35 E-11/3 Islamabad, Pakistan Phone: +92 -51 -222 1949 Web: www. pathfind. org Acknowledgement This initiative was funded by USAID | PAIMAN Project led by John Snow Inc. and implemented by Greenstar Social Marketing Pakistan (Guarantee) Limited
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