Abstract
Background
Different areas of disparities remain a concern in developing countries like Nepal regarding the utilization of maternal, neonatal and child health services like disparities in education, income, administrative regions, ethnic groups, province-level etc. In order to support equitable outcomes for Maternal, Neonatal and Child Health (MNCH) and to scale-up quality services, an Investment case was launched by developmental partners in the Asia-Pacific region. Investment Case (IC) at the local level aims to develop a coherent plan with local level development plans, which is equitable and responsive to the bottlenecks and the local needs. The study aims to identify the factors affecting equitable access to maternal health services in Nepal.
Methods
The study focuses on the impact of the intervention package developed by applying the investment case (IC) approach in maternal and child health services in Nepal introduced in 2011. Complex sample analysis was carried out to adjust the weight of the sample. Cross tabulation with Confidence Interval (CI) was used to generate weighted disaggregated data. Difference in Difference (DiD) analysis was carried out using a linear regression model. Finally, multivariate linear regression was carried out to figure out the effect of the intervention.
Results
Based on the data, the improvements before and after the intervention were calculated in both the intervention and comparison districts; no variables showed a significant association. Changes were similar for intervention and comparison areas: four antenatal care seeking (DiD=-4.8, p = 0.547 CI= -0.041-0.022), Skill Birth Attendance (SBA) delivery (DiD = 6.6, p = 0.325, CI= -0.010-0.039). Multivariable regression analysis also did not reveal any significant improvement in aggregate outcomes. The intervention did not play a significant role in any variables, i.e., four antenatal care seeking (p-value 0.062), SBA delivery (p-value 0.939).
Conclusion
The IC approach is itself a successful approach in most of the developing countries. After the implementation of IC, some of the MNCH indicators like ANC, SBA delivery have shown improvements in the intervention as well as comparison districts but have not shown significant with the intervention.
Commentary: should mother and child health services in developing countries be free?
