Ensuring financial access to emergency obstetric care: Three years of experience with Obstetric Risk Insurance in Nouakchott, Mauritania

Nouakchott Safe Motherhood Project, Direction Régionale des Affaires sanitaires et sociales, Nouakchott, Mauritania.
International Journal of Gynecology & Obstetrics (Impact Factor: 1.56). 12/2007; 99(2):183-90. DOI: 10.1016/j.ijgo.2007.07.006
Source: PubMed

ABSTRACT The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries.
In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity.
95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered.
This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.

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    • "Unofficial payments for nominally free, government-financed obstetric care have been documented in countries such as Nepal (Borghi et al., 2004), Tanzania (Mamdani and Bangser, 2004), Bangladesh (Nahar and Costello, 1998) and Mauritania (Renaudin, 2007). In ex-communist countries where public funding has collapsed, the growth of informal payments has been particularly severe. "
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    ABSTRACT: The cost of accessing maternity care in low and middle income countries falls heavily on users, contrib- • uting to the low uptake of key services such as deliveries in health facilities and limited access to emer-gency obstetric care. This is a particular challenge for poor households. Different strategies have been piloted in recent years to reduce out of pocket payments of various kinds • for maternity services. These include demand-side mechanisms such as user fee removal or reduction, community subsidies, social health insurance and provision of vouchers. Paying providers for perform-ance, use of contracts and budget reforms are among the supply-side measures intended to increase access to services. These strategies have resulted in a degree of success in some contexts, depending on localized factors • such as implementation capacity, external support and local ownership of the policy. Countries which have performed most strongly in improving access to maternity services have com- • bined a range of strategies addressing provider incentives as well as consumer costs. Using pooled funds (such as taxation) to finance emergency obstetric care should be a priority, given • the unpredictability, urgency and potentially catastrophic nature of these costs. Addressing core health systems issues, such as the capacity to deliver reliable funds and drugs to facili- • ties, and reliable and adequate salaries to staff, are critical to the quality, cost and sustainability of mater-nity services.
    Edited by J Hussein, A Mccaw-Binns, R Webber, 02/2012: chapter Financing Maternity Care;
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    • "However, using financial incentives only is an insufficient strategy to realise public health policies (Chaix- Couturier et al. 2000), or to ensure quality, efficiency and effectiveness, indicating the need for additional, multifaceted strategies (Rowe et al. 2005). For example, using an alternative SUSTAINING HEALTH SERVICES IN CAMBODIA financing approach for pregnant women in Mauritania, health facilities saw their workload and (official) remuneration package increase considerably, but this occurred at the expense of quality of care (Renaudin et al. 2007). Similarly, with contracting in Afghanistan, nearly all indicators associated with quantity of services improved, but mixed results were observed for quality of care (Hansen et al. 2008). "
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    ABSTRACT: Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study period-notably the development of performance indicators and targets and the performance monitoring.
    Health Policy and Planning 11/2009; 25(3):197-208. DOI:10.1093/heapol/czp049 · 3.00 Impact Factor
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