Improving Maternal Health Outcomes in Uganda: Cost-Effectiveness of Reproductive Health Vouchers and Community-Based Health Insurance

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

Financial barriers to health such as the introduction of user fees at the point of care result in decreased utilization of curative services of as much as 55%.  This USAID-supported study examined the cost-effectiveness of two financing strategies in Uganda that remove barriers in health care-seeking for women of reproductive age (WRA) through the use of economic subsidies.  Data on utilization and costs for reproductive health vouchers (RHVs) and community-based health insurance (CBHI) programs were collected via field observations from site visits in Western Uganda, desk reviews, and structured interviews with key informants. Costs of CBHI were gathered from costs of normal delivery, and enrollment in CBHI. Costs of deliveries reimbursed through RHVs were obtained from secondary data of the schemes managed by Marie Stopes Uganda. The impact of both strategies was calculated through the equivalent increase in facility-based deliveries that would lead to disability-adjusted life years (DALYs) averted.  The costs of facility deliveries ranged from USD $17.62-$18.79.  Almost 1356 DALYs were averted due to the increased number of health facility births from voucher use.   The incremental cost-effectiveness ratio (ICER) for the voucher program was USD $302/DALY averted.  The costs of subsidizing CBHI for one year for a pregnant woman was USD $59.26 including the costs of the package and delivery. CBHI coverage of maternity and malaria services corresponded to 19.9 DALYs gained. The ICER for the CBHI program was USD $298/DALY averted.   Both vouchers and CBHI schemes are highly cost-effective since they are less than Uganda’s per capita GNP of USD $510 per capita.  Policymakers can look to improve upon the goals of an equitable health system by employing voucher schemes that ensure adequate targeting of WRA, and through CBHI schemes that focus on household enrollment using a sliding-scale premium structure and further goals of universal health coverage (UHC).