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2 results on '"obstetric care utilisation"'

1. Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho.

Author

Steele, Sarah Jane, Sugianto, Hartini, Baglione, Quentin, Sedlimaier, Sandra, Niyibizi, Aline Aurore, Duncan, Kristal, Hill, Julia, Brix, Jesper, Philips, Mit, Cutsem, Gilles Van, and Shroufi, Amir

Subjects
*NEONATAL mortality, *USER charges, *HOSPITAL mortality, *MATERNAL health services, *STILLBIRTH, *MATERNAL mortality, *DELIVERY (Obstetrics), *HEALTH services accessibility, *HOSPITAL charges, *INFANT mortality
Abstract

Objective: Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co-payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho.Methods: We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives.Results: Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% - from 1547 to 2308 - and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital.Conclusion: Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries. [ABSTRACT FROM AUTHOR]

Published
2019
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2. Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho

Author

Jesper Brix, Hartini Sugianto, Gilles van Cutsem, Sarah Jane Steele, Kristal Duncan, Mit Philips, Aline Aurore Niyibizi, Sandra Sedlimaier, Julia Hill, Quentin Baglione, and Amir Shroufi

Subjects
Adult, neonatal mortality, retrospective study, 030231 tropical medicine, mortalité néonatale, maternal health, Health Services Accessibility, User fee, 03 medical and health sciences, Maternity care, 0302 clinical medicine, Pregnancy, District hospital, Chart review, Infant Mortality, Per capita, Humans, utilisation des soins obstétricaux, Medicine, Maternal Health Services, obstetric care utilisation, access to care, maternal mortality, business.industry, Neonatal mortality, Mortality rate, Public Health, Environmental and Occupational Health, Infant, Retrospective cohort study, Delivery, Obstetric, medicine.disease, Hospital Charges, Lesotho, Infectious Diseases, suppression des frais d'utilisation, user fee removal, Female, Original Article, étude rétrospective, Parasitology, Medical emergency, business, Original Research Papers
Abstract

Objective Lesotho has one of the highest maternal mortality rates in the world. While at primary health care (PHC) level maternity care is free, at hospital level co‐payments are required from patients. We describe service utilisation and delivery outcomes before and after removal of user fees and quality of delivery care, and associated costs, at St Joseph's Hospital (SJH) in Roma, Lesotho. Methods We compared utilisation of delivery services, stillbirths and maternal and neonatal mortality for the periods before (1 July 2012 to 31 December 2013) and after (1 January 2014 to 30 June 2015) user fee removal through a retrospective chart review and estimated additional costs attributed to user fee removal from provider (hospital) and patient perspectives. Results Of 4715 deliveries 3855 were at SJH and 860 at PHC centres. Of women delivering at SJH 684 (18.5%) were ≤19 years and 894 (23.6%) were HIV positive. After user fee removal hospital deliveries increased by 49% — from 1547 to 2308 — and neonatal mortality decreased from 4.8 to 1.3 per 1000 live births (P = 0.033). Extrapolating costs to the entire country, 1 USD per capita per year would allow user fee removal at hospital level, the provision of free transport to/from and accommodation at hospital. Conclusion Removing user fees for hospital delivery care in Lesotho is feasible and affordable, and has the potential to improve maternal and neonatal outcomes by removing financial barriers to skilled birth attendants and increasing coverage of institutional deliveries.

Published
2018

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