Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh
Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh
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DOI：
10.1016/j.socscimed.2011.03.031
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发表时间：
2011-05-01
影响因子：
5.4
通讯作者：
Khan, M. Mahmud
中科院分区：
文献类型：
--
作者：
Ahmed, Shakil;Khan, M. Mahmud
需求方融资（DSF）用于世界上欠发达国家，以改善获得医疗保健的机会并鼓励市场供应。根据DSF，家庭收到可用于支付医疗保健服务的代金券。本研究评估了孟加拉国普及DSF对孕产妇保健服务利用的影响。在该项目启动一年后，在学券计划地区及其周围进行了一次住户调查。对调查前一年内生育的妇女进行了访谈。项目区所有社会经济群体的孕产妇保健服务利用率均高于对照区。在项目地区，产妇在分娩过程中得到熟练保健人员协助的可能性高出3.6倍，在保健设施分娩的可能性高出2.5倍，接受产后护理的可能性高出2.8倍，获得产前护理的可能性增加2.0倍（ANC）与未参加该方案的孕妇相比，寻求产科并发症治疗的可能性高出1.5倍。项目区孕产妇保健服务利用方面的社会经济不平等程度也低于对照区。凭证的使用证明对穷人产生了更强的增加需求的效果。贫穷的代金券接受者在卫生设施分娩的可能性是非贫穷接受者的4.3倍，在分娩时使用熟练卫生人员的可能性是非贫穷接受者的两倍。与反向公平假设相反，代金券计划甚至在短期内减少了不平等。尽管取得了这些进展，但在利用孕产妇保健服务方面的社会经济差距仍然有利于富人，这意味着单靠需求方筹资不足以实现孕产妇保健方面的千年发展目标。需要采取全面的全系统办法，包括加强供应方，以充分解决贫穷发展中国家的产妇保健问题。(C)2011爱思唯尔有限公司版权所有。
Demand-side financing (DSF) is used in the less-developed countries of the world to improve access to healthcare and to encourage market supply. Under DSF, households receive vouchers that can be used to pay for healthcare services. This study evaluated the effects of a universal DSF on maternal healthcare service utilization in Bangladesh. A household survey was conducted in and around the voucher scheme area one year after the initiation of the project. Women who gave birth within a year prior to the survey were interviewed. The utilization rates of maternal health services were found to be higher for all socioeconomic groups in the project area than in the comparison areas. Voucher recipients in the project area were 3.6 times more likely to be assisted by skilled health personnel during delivery, 2.5 times more likely to deliver the baby in a health facility, 2.8 times more likely to receive postnatal care (PNC), 2.0 times more likely to get antenatal care (ANC) services and 1.5 times more likely to seek treatment for obstetric complications than pregnant women not in the program. The degree of socioeconomic inequality in maternal health service utilization was also lower in the project area than in the comparison area. The use of vouchers evidenced much stronger demand-increasing effects on the poor. Poor voucher recipients were 4.3 times more likely to deliver in a health facility and two times more likely to use skilled health personnel at delivery than the non-poor recipients. Contrary to the inverse equity hypothesis, the voucher scheme reduced inequality even in the short run. Despite these improvements, socioeconomic disparity in the use of maternal health services has remained pro-rich, implying that demand-side financing alone will be insufficient to achieve the Millennium Development Goal for maternal health. A comprehensive system-wide approach, including supply-side strengthening, will be needed to adequately address maternal health concerns in poor developing countries. (C) 2011 Elsevier Ltd. All rights reserved.