Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria

Authors: Anthony I. Ajayi, Wilson Akpan

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

The reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates. Evidence of whether user-fee removal benefits the poor women in underserved settings is scanty and inconsistent. This article examines use of maternal health care services in the context of free maternal healthcare and profiles the beneficiaries of user-fee removal.

Methods

The study adopted a descriptive design. A three-stage cluster sampling method was used to select a representative sample of 1227 women who gave birth between 2011 and 2015. Questionnaires were administered using a face-to-face interview approach and data generated were analysed using descriptive and inferential statistics.

Results

The analysis shows that the use of maternal healthcare services has improved considerably in North Central and Southwestern Nigeria. While socioeconomic and geographical inequality in the use of maternal healthcare services appear to be disappearing in Southwestern Nigeria, it appears to be widening in North Central Nigeria. The findings indicate that 33.6% of women reported to have benefitted from the free child-delivery programme; however, substantial variation exists across the two regions. The proportion of beneficiaries of user-fee removal policy was highest in urban areas (35.9%), among women belonging to the middle income category (38.3%), among women who gave birth in primary health centres (63.1%) and among women who resided in communities where there was availability of health facilities (37.2%).

Conclusion

The study concludes that low coverage of the free maternal health programme, especially among women of low socioeconomic status residing in underserved settings is among the reasons for persistent poor maternal health outcomes in the context of free maternal healthcare. A model towards improving maternal health in underserved settings, especially in North Central Nigeria, would entail provisioning of health facilities as well as focusing on implementing equitable maternal health policies.
Literature
1.
World Health Organization: State of inequality: reproductive, maternal, newborn and child health. 2015.
2.
Paruzzolo S, Mehra R, Kes A, Ashbaugh C: Targeting poverty and gender inequality to improve maternal health. 2010.
3.
Matthews Z, Channon A, Neal S, Osrin D, Madise N, Stones W. Examining the “urban advantage” in maternal health care in developing countries. PLoS Med. 2010;7(9):e1000327.CrossRefPubMedPubMedCentral
4.
World Health Organization, UNICEF: trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division. 2015.
5.
McKinnon B, Harper S, Kaufman JS, Bergevin Y. Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan African countries. Health Policy Plan. 2015;30(4):432–41.CrossRefPubMed
6.
Dzakpasu S, Powell-Jackson T, Campbell OM. Impact of user fees on maternal health service utilization and related health outcomes: a systematic review. Health Policy Plan. 2013;29(2):137–50.CrossRefPubMed
7.
Ridde V, Morestin F. A scoping review of the literature on the abolition of user fees in health care services in Africa. Health Policy Planning. 2011;26(1):1–11.CrossRefPubMed
8.
Ponsar F, Van Herp M, Zachariah R, Gerard S, Philips M, Jouquet G. Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali. Health Policy Planning. 2011;26(Suppl 2):ii72–83.PubMed
9.
Langlois ÉV, Karp I, Serme JDD, Bicaba A. Effect of a policy to reduce user fees on the rate of skilled birth attendance across socioeconomic strata in Burkina Faso. Health Policy Planning. 2016;31(4):462–71.CrossRefPubMed
10.
McKinnon B, Harper S, Kaufman JS. Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone. Soc Sci Med. 2015;135:117–23.CrossRefPubMed
11.
Braveman P, Tarimo E. Social inequalities in health within countries: not only an issue for affluent nations. Soc Sci Med. 2002;54(11):1621–35.CrossRefPubMed
12.
Atchessi N, Ridde V, Zunzunegui M-V. User fees exemptions alone are not enough to increase indigent use of healthcare services. Health Policy Planning. 2016;31(5):674–81.CrossRefPubMed
13.
14.
Nabyonga J, Desmet M, Karamagi H, Kadama PY, Omaswa F, Walker O. Abolition of cost-sharing is pro-poor: evidence from Uganda. Health Policy Planning. 2005;20(2):100–8.CrossRefPubMed
15.
Johnson FA. A geospatial analysis of the impacts of maternity care fee payment policies on the uptake of skilled birth care in Ghana. BMC Pregnancy Childbirth. 2016;16(1):1.CrossRef
16.
Zere E, Kirigia JM, Duale S, Akazili J. Inequities in maternal and child health outcomes and interventions in Ghana. BMC Pub Health. 2012;12:252.CrossRef
17.
El-Khoury M, Hatt L, Gandaho T. User fee exemptions and equity in access to caesarean sections: an analysis of patient survey data in Mali. Int J Equity Health. 2012;11(49):1–7.
18.
Ameur AB, Ridde V, Bado AR, Ingabire M-G, Queuille L. User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation. BMC Health Serv Res. 2012;12(1):412.CrossRefPubMedPubMedCentral
19.
De Allegri M, Ridde V, Louis VR, Sarker M, Tiendrebéogo J, Yé M, Müller O, Jahn A. Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso. Health Policy. 2011;99(3):210–8.CrossRefPubMed
20.
World Health Organization: Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF. UNFPA, the World Bank and the United Nations Population Division Geneva, World Health Organization Error! Hyperlink reference not valid. apps who int/ iris/ bitstream 2014, 10665(112682):2.
21.
National Population Commission [Nigeria] and ICF International. Nigeria demographic and health survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International; 2014.
22.
Okonofua F. Editorial: reducing maternal mortality in Nigeria: an approach through policy research and capacity building. Afr J Reprod Health. 2014;14(3):9–14.
23.
Cooke J, Tahir F. Maternal health in Nigeria: with leadership, progress is possible. Washington DC, USA: Center for Strategic and International Studies (CSIS); 2013.
24.
Saka M, Isiaka S, Akande T, Saka A, Agbana B, Bako I. Health related policy reform in Nigeria: empirical analysis of health policies developed and implemented between 2001 to 2010 for improved sustainable health and development. J Public Adm Policy Res. 2012;4(3):50.
25.
26.
Okonofua F, Lambo E, Okeibunor J, Agholor K. Advocacy for free maternal and child health care in Nigeria—results and outcomes. Health Policy. 2011;99(2):131–8.CrossRefPubMed
27.
28.
Dzakpasu S, Soremekun S, Manu A, ten Asbroek G, Tawiah C, Hurt L, Fenty J, Owusu-Agyei S, Hill Z, Campbell OM. Impact of free delivery care on health facility delivery and insurance coverage in Ghana’s Brong Ahafo region. PLoS One. 2012;7(11):e49430.CrossRefPubMedPubMedCentral
29.
Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Org. 2007;85(10):812–9.CrossRefPubMedPubMedCentral
30.
Stephenson R, Baschieri A, Clements S, Hennink M, Madise N. Contextual influences on the use of health facilities for childbirth in Africa. Am J Public Health. 2006;96(1):84–93.CrossRefPubMedPubMedCentral
Metadata
Title
Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria
Authors
Anthony I. Ajayi
Wilson Akpan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2560-1

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

The influence of total hysterectomy in a cervical cancer screening population: a register-based cross-sectional study

Research article

Role of mHealth applications for improving antenatal and postnatal care in low and middle income countries: a systematic review

Research article

Repeat testing for chlamydia trachomatis, a “safe approach” to unsafe sex? a qualitative exploration among youth in Stockholm

Research article

A qualitative analysis of the effectiveness of telehealthcare devices (i) are they meeting the needs of end-users?

Research article

Improving patient safety culture in Saudi Arabia (2012–2015): trending, improvement and benchmarking

Research article

Microblogging violent attacks on medical staff in China: a case study of the Longmen County People’s Hospital incident