Efforts to Promote Equitable Financing Mechanisms in Support Of Maternal Health Programs by Removing Financial Barriers, Especially Direct Payments in Kano, Northern Nigeria

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: There is now broad consensus that health user fees ‘punish the poor and prevent people from accessing life-saving treatment. According to WHO, user fees are ‘the most inequitable method for financing health-care services. In recent years, governments of several low-income countries have taken decisive action by removing fully or partially user fees in the health sector. The analysis shows that African leaders are willing to take strong action to remove financial barriers met by vulnerable groups, especially pregnant women and children. Free “Maternal Health Care” has received particular attention from governments. In Kano State, it was estimated that the state maternal mortality ratio (MMR) was 1600 deaths/1000, 000 live births, three times the national (Nigerian) average and up to 56% of women reported that getting money for treatment was a serious problem in accessing health care.

Methodology: Introduction of free maternal and child health services in 2011 that includes antenatal care with drugs, government hospitals delivery and other post-delivery care and management. Available records were obtained from 3 pilots’ hospitals selected during the fee exemption phase (2011-2013), and during an equivalent duration of time prior to the fee exemption phase (2008-2010).

Results: In the 3 hospitals combined 2535 deliveries took place, 831 (32.8%) before fee exemption while 1,704 (67.2%) took place within the same period after fee exemption and intervention of free Maternal and Child Health, MCH policy implementation.

Conclusions: This study found that there was a significant increase in the likelihood of delivering in a health facility after the implementation of the fee exemption policy. The Kano State free MCH with fee exemption policy particularly assisted some groups of the population who were likely to have the biggest financial barriers in delivering in health facilities, this may have resulted in reduced maternal mortality and morbidity.