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Bou-Karroum L, Iaia DG, El-Jardali F, Abou Samra C, Salameh S, Sleem Z, Masri R, Harb A, Hemadi N, Hilal N, Hneiny L, Nassour S, Shah MG, Langlois EV. Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003573. [PMID: 39264949 PMCID: PMC11392393 DOI: 10.1371/journal.pgph.0003573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/15/2024] [Indexed: 09/14/2024]
Abstract
Over the past few decades, the world has witnessed considerable progress in women's, children's and adolescents' health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs). This scoping review was conducted following Joanna Briggs Institute (JBI) guidance for conducting such reviews as well as the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for reporting scoping reviews. We searched Medline, PubMed, EMBASE and the World Health Organization's (WHO) Global Index Medicus, and relevant websites. The selection process was conducted in duplicate and independently. Out of 26 355 citations identified from electronic databases, relevant website searches and stakeholders' consultations, 413 studies were included in the final review. Conditional cash transfers (CCTs) (22.3%), health insurance (21.4%), user fee exemptions (18.1%) and vouchers (16.9%) were the most reported financial interventions and measures. The majority were targeted at women (57%) and children (21%) with others targeting adolescents (2.7%) and newborns (0.7%). The findings highlighted that CCTs, voucher programs and various insurance schemes can improve the utilization of maternal and child health services for the poor and the disadvantaged, and improve mortality and morbidity rates. However, multiple implementation challenges impact the effectiveness of these programmes. Some studies suggested that financial interventions alone would not be sufficient to achieve equity in health coverage among those of a lower income and those residing in remote regions. This review provides evidence on financing interventions to address the health needs of the most vulnerable communities. It can be used to inform the design of equitable health financing policies and health system reform efforts that are essential to moving towards universal health coverage (UHC). By also unveiling the knowledge gaps, it can be used to inform future research on financing interventions and measures to improve equity when addressing WCAH in LMICs.
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Affiliation(s)
- Lama Bou-Karroum
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Domenico G Iaia
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Fadi El-Jardali
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Clara Abou Samra
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Sabine Salameh
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Zeina Sleem
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Reem Masri
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Nour Hemadi
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Nadeen Hilal
- Department of Internal Medicine, Ain Wazein Medical Village, Ain Wazein, Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Sahar Nassour
- Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon
| | - Mehr Gul Shah
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
| | - Etienne V Langlois
- Partnership for Maternal Newborn and Child Health, World Health Organisation, Geneva, Switzerland
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Effect of Implementing a Free Delivery Service Policy on Women's Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis. J Pregnancy 2020; 2020:8649598. [PMID: 33414963 PMCID: PMC7752279 DOI: 10.1155/2020/8649598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/27/2020] [Accepted: 11/30/2020] [Indexed: 12/03/2022] Open
Abstract
Background Access to and utilization of facility delivery services is low in Ethiopia. The government of Ethiopia introduced a free delivery service policy in all public health facilities in 2013 to encourage mothers to deliver in health facilities. Examining the effect of this intervention on the utilization of delivery services is very important. Objective In this study, we assessed the effect of provisions of free maternity care services on facility-based delivery service utilization in central Ethiopia. Methods Data on 108 time points were collected on facility-based delivery service utilization (72 pre- and 36 postintervention) for a period of nine years from July 2007 to June 2016. Routine monthly data were extracted from the District Health Information System and verified using data from the delivery ward logbooks across the study facilities. An interrupted time-series analysis was conducted to assess the effect of the intervention. Results The implementation of the free delivery services policy has significantly increased facility deliveries. During the study period, there was a statistically significant increase in the number of facility-based deliveries after the 24th and 36th months of intervention (p < 0.05). Program effects on the use of public facilities for deliveries were persisted over a longer exposure period. Conclusion The findings suggested that the provision of free delivery services at public health facilities increased facility delivery use. The improved utilization of facility delivery services was more marked over a longer exposure period. Policy-makers may consider mobilizing the communities aware of the program at its instigation.
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Mac-Seing M, Zinszer K, Oga Omenka C, de Beaudrap P, Mehrabi F, Zarowsky C. Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review. Glob Health Promot 2020; 27:97-106. [PMID: 32748728 PMCID: PMC7750661 DOI: 10.1177/1757975920941435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/12/2020] [Indexed: 11/15/2022]
Abstract
Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Kate Zinszer
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Charity Oga Omenka
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Pierre de Beaudrap
- Centre Population et Développement
(CEPED), Institut de recherche pour le développement, Paris, France
| | - Fereshteh Mehrabi
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Department of Health Management,
Evaluation and Health Policy, School of Public Health, Université de
Montréal, Montreal, Canada
| | - Christina Zarowsky
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
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Iyanda AE, Oppong JR, Hamilton P, Tiwari C. Using GIS to detect cluster and spatial disparity in maternal health indicators: a need for social health interventions. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:449-466. [PMID: 30426852 DOI: 10.1080/19371918.2018.1543628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Maternal mortality remains a serious global health concern. Although global efforts have produced some encouraging results in some World Health Organization's health regions, disparities persist within many countries. Additionally, in many developing countries, inadequate documentation of various health events including maternal mortality and morbidity, make it difficult to determine the true extent of the problem. Maternal health indicators are therefore proxies used in estimating health status in developing countries. Using geospatial and geovisualization techniques, this study examines district level disparities in two maternal health indicators in Ghana antenatal care (ANC) visits and skilled birth attendance (SBA). The results reveal districts with complete lack of access to higher health care professionals and others with underutilization of antenatal services. The findings provide important input for targeting location-specific public health and maternal health interventions.
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Affiliation(s)
- Ayodeji E Iyanda
- a Department of Geography , Texas State University , San Marcos , Texas , USA
| | - Joseph R Oppong
- b Department of Geography and the Environment , University of North Texas , Denton , Texas , USA
| | | | - Chetan Tiwari
- b Department of Geography and the Environment , University of North Texas , Denton , Texas , USA
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Carvajal-Aguirre L, Mehra V, Amouzou A, Khan SM, Vaz L, Guenther T, Kalino M, Zaka N. Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi. J Glob Health 2018; 7:020508. [PMID: 29423185 PMCID: PMC5804506 DOI: 10.7189/jogh.07.020508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Health facility service environment is an important factor for newborns survival and well–being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. Methods We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Results Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19–1.95, P = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50–2.83, P < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. Conclusions There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.
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Affiliation(s)
| | - Vrinda Mehra
- Data and Analytics, Data Research and Policy, UNICEF, New York, New York, USA
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Shane M Khan
- Data and Analytics, Data Research and Policy, UNICEF, New York, New York, USA
| | - Lara Vaz
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - Tanya Guenther
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| | | | - Nabila Zaka
- Program Division, UNICEF, New York, New York, USA
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Ajayi AI, Akpan W. Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria. BMC Health Serv Res 2017; 17:620. [PMID: 28865462 PMCID: PMC5581419 DOI: 10.1186/s12913-017-2560-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/18/2017] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Anthony I Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa.
| | - Wilson Akpan
- Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
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