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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background In sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities’ perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage. Methods We conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers. Results The results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers’ attitudes, distance and transportation difficulties, and perceived poor quality of health services. Conclusions Moving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks.
    BMC Health Services Research 05/2014; 14(1):234. · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year nearly three million women die due to pregnancy related causes. This tragedy is avoidable if women have timely access to required emergency obstetric care. Emergency obstetric care refers to life-saving services for maternal and neonatal complications provided by skilled health workers. Since the beginning of the 1980’s, several efforts have been intensified to improve maternal and child health status and reducing the high morbidity and mortality. There was built on a worldwide consensus to provide improved maternal and child health care for addressing the high morbidity and mortality. All participant countries agreed to integrate emergency obstetric care services in their national health care system. Emergency obstetric care is one of the strategies for reducing the maternal mortality as pregnancy related complications are unpredictable. However, many women in developing countries do not have access to essential health care services including emergency obstetric care. Basic emergency obstetric care by skilled birth attendants or timely referral for further comprehensive emergency obstetric care can reduce maternal deaths and disabilities significantly. This paper is based on the results published in PubMed, Medline, Lancet, WHO and Google Scholar web pages from 1990 to 2013. Keywords: developing countries, emergency obstetric care, maternal mortality, Nepal.
    Nepal Journal of Obstetrics and Gynaecology 06/2014;
  • Source
    [Show abstract] [Hide abstract]
    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;


Available from