Impact Evaluation of the Demand-Side Financing Program for Maternal Health in Bangladesh - PowerPoint PPT Presentation

Loading...

PPT – Impact Evaluation of the Demand-Side Financing Program for Maternal Health in Bangladesh PowerPoint presentation | free to view - id: 59b1ff-M2NiN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Impact Evaluation of the Demand-Side Financing Program for Maternal Health in Bangladesh

Description:

Impact Evaluation of the Demand-Side Financing Program for Maternal Health in Bangladesh – PowerPoint PPT presentation

Number of Views:801
Avg rating:3.0/5.0
Slides: 16
Provided by: GTZ98
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Impact Evaluation of the Demand-Side Financing Program for Maternal Health in Bangladesh


1
Impact Evaluation of the Demand-Side Financing
Program for Maternal Health in Bangladesh
  • Laurel Hatt, Ha Nguyen, Nancy Sloan, Sara Miner,
    Obiko Magvanjav, Asha Sharma, Jamil Chowdhury,
    Rezwana Chowdhury, Dipika Paul, Mursaleena Islam,
    and Hong Wang

2
Bangladesh context
  • High maternal mortality ratio (MMR) 320 maternal
    deaths per 100,000 live births
  • 85 of deliveries at home, few with medical
    provider
  • Millennium Development Goal 5 Cut MMR to 143 by
    2015

3
Bangladesh pilot DSF program
  • Aims to rapidly increase utilization of maternal
    health (MH) services via
  • Vouchers for free antenatal (ANC), delivery,
    emergency, and postnatal care (PNC), and for
    transportation
  • Cash transfers (Tk. 2000 30) and gift bags if
    women deliver with skilled birth attendant at
    home or in facility
  • Cash incentives for providers/field workers for
    registering women and providing MH services
    seed fund for facilities
  • Eligibility local residents only pregnant for
    1st or 2nd time used family planning prior to
    2nd pregnancy means testing in some areas
  • Started in 2007 in 21 subdistricts now in 45

4
Evaluation objectives
  • Evaluate DSF program impacts on
  • Use of skilled providers at delivery, C-section,
    ANC, and PNC
  • Out-of-pocket expenditures on maternal health
    services
  • Provider skills, knowledge facility quality
  • Assess operations of the DSF program

ANC visit by voucher recipient
5
Methods
  • Lack of useable baseline data
  • 21 DSF subdistricts matched with 21 control
    subdistricts
  • Data sources
  • Household survey (N2,208) of women who delivered
    in prior six months
  • 10 focus group discussions with women
  • 16 facility assessments
  • 51 provider interviews
  • 90 key informant interviews at subdistrict and
    central levels
  • Administrative reports
  • Descriptive and multivariate analyses

6
Findings
  • New mothers line up to receive cash stipends and
    gift boxes

7
receiving ANC significantly higher in voucher
areas
8
delivering with a skilled provider
significantly higher in voucher areas
9
More home deliveries attended by qualified birth
attendants
10
with PNC visit significantly higher in voucher
areas
11
OOP expenditure significantly lower in voucher
areas
12
Multivariate analyses confirm impact
  • Cross-sectional regression
  • Compared to living in a control subdistrict,
    residence in a DSF subdistrict increased the
    likelihood of delivery with skilled provider by
    42 to 50 percentage points
  • Using pre- and post-DSF birth history data
    from recently delivered women
  • Difference-in-differences and fixed effects
    analyses also confirmed program impacts

13
Conclusions Strong DSF impacts
  • Women in DSF areas were significantly more likely
    to have at least 3 ANC visits (55) than women in
    the control areas (34).
  • The DSF program is significantly associated with
    higher rates of delivery with qualified providers
    -- more than twice as high in DSF (64) as in
    control subdistricts (27).
  • No significant differences in C-section rates
    (10 vs. 9)
  • Women in DSF areas spent significantly less on
    pregnancy delivery care than women in control
    areas

14
Challenges remain
  • Big upsurge in patient volumes is overwhelming
  • Shortages of human resources, supplies and
    medicines
  • Limited targeting
  • Leakage to higher-parity women (11 of
    recipients)
  • Little income targeting in means-tested areas
  • Delays in funds disbursements are a serious
    problem
  • Impact of incentives (to providers and consumers)
    diminished if not connected with desired
    behaviors
  • Cost and sustainability concerns

15
Acknowledgements
  • GTZ funded the original study, which was
    implemented by Abt Associates Inc. (USA) and its
    partner RTM International (Bangladesh)
  • Special thanks to the Bangladesh Ministry of
    Health and Family Welfare, Health Economics Unit,
    WHO and DSF program office for their support
  • http//www.abtassociates.com/HSRsymposium
About PowerShow.com