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Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho
- Source :
- Tropical Medicine & International Health
- Publication Year :
- 2018
- Publisher :
- Wiley, 2018.
-
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.
- 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
Subjects
Details
- ISSN :
- 13602276
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- Tropical Medicine & International Health
- Accession number :
- edsair.doi.dedup.....bf193c4fdaf0c77b7ff37115a57dcf07