Economic burden of out-of-pocket expenditure, productivity cost during pregnancy and COVID-19 impact on household economy in a cohort of pregnant women in Anuradhapura District, Sri Lanka; A study protocol

Background: Investigating the out-of-pocket expenditure (OOPE) associated with maternal health is important since OOPE directly affects the affordability of health services. Global evidence suggests the importance of capturing the productivity cost during pregnancy in terms of absenteeism and presenteeism. Furthermore, the impact of the ongoing COVID-19 pandemic on the household economy needs to be further evaluated as pregnant women are one of the most vulnerable groups. This study aims at determining the economic burden of OOPE, productivity cost, and COVID-19 impact on pregnant women's household economy in a cohort of pregnant women in Anuradhapura District, Sri Lanka. Methods: The study setting is all 22 Medical Officer of Health (MOH) areas in Anuradhapura district, Sri Lanka. The study has three components; a follow-up study of a cohort of pregnant women to assess the magnitude and associated factors of OOPE and to assess the productivity cost (Component 1), a qualitative case study to explore the impact and causes of the OOPE under free health services (Component 2) and a cross-sectional study to describe the effects of COVID-19 outbreak on household economy (Component 3). The study samples consist of 1,393 and 1,460 participants for components one and three, respectively, and 25 pregnant women will be recruited for component two. The data will be analyzed using descriptive, parametric, and non-parametric statistics for the first and third components and thematic analysis for the second component. Discussion: With the lack of evidence on OOPE, productivity loss/cost in terms of maternal health, and COVID-19 impact on household economy in Sri Lanka, the evidence generated from this study would be valuable for policymakers, health care administrators, and health care practitioners globally, regionally, and locally to plan for future measures for reducing the OOPE, productivity loss/cost, and minimizing the economic hardship of the COVID-19 outbreak during pregnancy.

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Access to Maternal Health Services during COVID-19

Europasian Journal of Medical Sciences ◽

10.46405/ejms.v2i2.110 ◽

2020 ◽

Vol 2 (2) ◽

pp. 48-52 ◽

Cited By ~ 2

Author(s):

Smriti Pant ◽

Saugat Koirala ◽

Madhusudan Subedi

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Pregnant Women ◽

Care Delivery ◽

Health Care Delivery System ◽

Maternal Health Services ◽

Global Scale ◽

Health Care Facilities ◽

Movement Restriction

Most causes of maternal morbidity and mortality can be prevented by giving prompt, suitable treatment to the women by qualified health practitioners. Maternal health services (MHS), which include antenatal care, delivery care, and postnatal care, can play a crucial role in preventing maternal health problems. The recent coronavirus disease (COVID-19) pandemic has had a disastrous effect on the health care delivery system of people of all ages, on a global scale but pregnant women face particular challenges. The aim of this review is to assess the effect of COVID-19 on access to MHS. For writing this narrative review, national and international reports on maternal health services during COVID-19, along with journal articles on the related topic were reviewed. Due to this pandemic, women worldwide are facing more barriers to accessing maternal health care, including restrictions, transport challenges, and anxiety over possibly being exposed to coronavirus. Many women preferred not to seek healthcare due to the fear of themselves being infected with the virus or transmitting it to their unborn babies. Additionally, movement restriction has made it difficult for many pregnant women to reach health care facilities. Even those who managed to reach health facilities have reported not receiving timely care. As a result, a considerable rise in maternal mortality globally has been estimated over the next six months. Despite the circumstances, efforts have been made to boost maternal health in both developed and developing countries. This pandemic has highlighted the importance of health preparedness with special attention given to vulnerable people like pregnant women and newborns while planning for such events. Keywords: Childbirth, COVID19, Maternal Health, Pandemic, Pregnancy, Women’s health

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How Costly is the First Prenatal Clinic Visit? Analysis of Out-of-Pocket Expenditure in Rural Sri Lanka - A Country With Free Maternal Health Care

10.21203/rs.3.rs-523511/v1 ◽

2021 ◽

Author(s):

Sajaan Praveena Gunarathne ◽

Nuwan Darshana Wickramasinghe ◽

Thilini Chanchala Agampodi ◽

Indika Ruwan Prasanna ◽

Suneth Buddhika Agampodi

Keyword(s):

Sri Lanka ◽

Maternal Health ◽

Health Services ◽

Pregnant Women ◽

Maternal Health Services ◽

Cross Sectional Study ◽

Clinic Visit ◽

Cross Sectional ◽

The Mean ◽

Study Setting

Abstract Background: This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare. Methods: The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health areas in Anuradhapura District, Sri Lanka. Data of 1,389 pregnant women were analyzed using descriptive statistics and non-parametric tests. Results: The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9% and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs=0.095, p=0.002) and the number of pregnancies (rs=-0.155, p<0.001) with OOPE. Conclusion: Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost.

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How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

BMC Health Services Research ◽

10.1186/s12913-021-07005-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sajaan Praveena Gunarathne ◽

Nuwan Darshana Wickramasinghe ◽

Thilini Chanchala Agampodi ◽

Indika Ruwan Prasanna ◽

Suneth Buddhika Agampodi

Keyword(s):

Sri Lanka ◽

Maternal Health ◽

Health Services ◽

Pregnant Women ◽

Maternal Health Services ◽

Cross Sectional Study ◽

Clinic Visit ◽

Cross Sectional ◽

The Mean ◽

Study Setting

Abstract Background This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare. Methods The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests. Results The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs = 0.095, p = 0.002) and the number of pregnancies (rs = − 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05). Conclusion Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.

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Assessment of Tribal Healthcare Infrastructure for Delivery of Maternal Health Program in Balasore District, Odisha, India

Asia Pacific Journal of Health Management ◽

10.24083/apjhm.v16i3.999 ◽

2021 ◽

Vol 16 (3) ◽

pp. 165-173

Author(s):

Ranjit Kumar Dehury

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Pregnant Women ◽

Health Program ◽

Health Information System ◽

Maternal Health Services ◽

Health Care Facilities ◽

Clinical Practices ◽

District Hospitals

Introduction: There are still large number of maternal deaths in India nearing up to 50,000 deaths in a year which is one sixth of the world in recent years. Odisha (India) is also not performing well in maternal health care management despite its commitment in MDG and SDG. Odisha constitute 23% of tribal population, where the maternal mortality is very high and difficult to provide health services, particularly maternal health services. The study aims to assess provision of necessary health services for pregnant women in an inaccessible tribal pockets. Methods: The study was conducted in Balasore district, Odisha (India) where a sizable population is consisting of various indigenous tribes, particularly in some blocks. The Parijata tool was used to assess various health care facilities which was developed by UNICEF and ARTH, Rajasthan. By this, availability of basic things like manpower, drugs and consumables are assessed along with laid down clinical practices and procedures. Results: The study found that there is lack of provisioning of health services in healthcare facilities. Both District hospital at Balasore and Sub-district hospitals lack basic services recommended by WHO for taking care of women. Further, the effort of government to implement a uniform program across the state hinder the tailoring of services for tribal pockets. Conclusion: The study provides remedial measures for improving the role and functioning of grass roots workers, integrating indigenous medicine with biomedicine, and revamping health information system to incorporate cultural features, thereby improving its utilization in the study area. The study raised critical issues about potential of maternal health program to deliver effective care of pregnant women in tribal dominated areas.

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Exploring COVID-19 Related Factors Influencing Antenatal Care Services Uptake: A Qualitative Study among Women in a Rural Community in Southwest Ethiopia

Journal of Primary Care & Community Health ◽

10.1177/2150132721996892 ◽

2021 ◽

Vol 12 ◽

pp. 215013272199689

Author(s):

Shewangizaw Hailemariam ◽

Wubetu Agegnehu ◽

Misganaw Derese

Keyword(s):

Health Care ◽

Maternal Health ◽

Qualitative Study ◽

Antenatal Care ◽

Pregnant Women ◽

Health Facility ◽

Care Service ◽

Maternal Health Service ◽

Related Factors ◽

Factors Influencing

Introduction: Evidences suggest a significant decline in maternal health service uptake following the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia. However, COVID-19 related factors impacting the service uptake are not sufficiently addressed. Hence, the current study was intended to explore COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia. Methods: A community-based qualitative study was conducted from September 25/2020 to November 25/2020 among selected pregnant women residing in rural districts of Bench-Sheko Zone, and healthcare providers working in the local health care facilities. Six focus group discussions and 9 in-depth interviews were made between pregnant women, and health care providers, respectively. Data was collected by health education and behavioral science professionals who also have experience in qualitative data collection procedure. Data were transcribed, translated, and analyzed thematically using Open Code 4.0 software. Result: The study revealed several COVID-19 related factors influencing the uptake of antenatal care service during the pandemic. Health facility related barriers, perceived poor quality of care during the pandemic, government measures against COVID-19, anxiety related to the pandemic, and risk minimization were the identified factors possibly influencing the current antenatal care service uptake among women in rural Bench-Sheko Zone. Conclusion: COVID-19 preventive measures, and health facility related factors and individual factors were responsible for the current decline in antenatal care service uptake. Preserving essential health care service is critical to prevent avoidable losses of maternal and child lives during the pandemic period. Hence, programs and strategies designed to maintain maternal health services particularly, antenatal care service have better take the above determinants into consideration.

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Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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The Impact of Hypoglycemia on Productivity Loss and Utility in Type 2 Diabetes Patients Treated with Insulin in Real-World Canadian Practice: Protocol for a Prospective Study (Preprint)

10.2196/preprints.35461 ◽

2021 ◽

Author(s):

Veronique Lambert-Obry ◽

Jean-Philippe Lafrance ◽

Michelle Savoie ◽

Jean Lachaine

Keyword(s):

Type 2 Diabetes ◽

Prospective Study ◽

Real World ◽

Productivity Loss ◽

Economic Modeling ◽

Economic Evaluations ◽

Productivity Cost ◽

Productivity Losses ◽

The Impact

BACKGROUND Type 2 diabetes mellitus (T2DM) imposes a significant burden, with its increasing prevalence and life-threatening complications. In patients not achieving glycemic targets on oral antidiabetic drugs, initiation of insulin is recommended. However, a serious concern about insulin is drug-induced hypoglycemia. Hypoglycemia is known to affect quality of life and healthcare resource utilization. However, health economics and outcomes research (HEOR) data for economic modeling are limited, particularly in terms of utility values and productivity losses. OBJECTIVE The aim of this real-world prospective study is to assess the impact of hypoglycemia on productivity and utility in insulin-treated T2DM adults from Ontario and Quebec (Canada). METHODS This noninterventional, multicenter, 3-month prospective study will recruit patients from four medical clinics and two endocrinology/diabetes clinics. Patients will be identified using appointment lists, and enrolled through consecutive sampling during routinely scheduled consultations. To be eligible, patients must be ≥18 years of age, diagnosed with T2DM, and treated with insulin. Utility and productivity will be collected using the EQ-5D-5L questionnaire and the iMTA Productivity Cost Questionnaire (iPCQ), respectively. Questionnaires will be completed at 4, 8 and 12 weeks after recruitment. Generalized estimating equations (GEE) models will be used to investigate productivity losses and utility decrements associated with incident hypoglycemic events while controlling for individual patient characteristics. A total of 500 patients will be enrolled to ensure precision of HEOR estimates. RESULTS This study is designed to fill a gap in the Canadian evidence on the impact of hypoglycemia on HEOR outcomes. More specifically, it will generate productivity and utility inputs for economic modeling in T2DM. CONCLUSIONS Insulin therapies are expensive, and hypoglycemia is a significant component of economic evaluations. Robust HEOR data may help health technology assessment (HTA) agencies in future reimbursement decision making.

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Intervention Time Series Modeling of Infant Mortality: Impact of Free Maternal Health Care

Asian Journal of Probability and Statistics ◽

10.9734/ajpas/2020/v8i430213 ◽

2020 ◽

pp. 38-47

Author(s):

J. Kisabuli ◽

J. Ong'ala ◽

E. Odero

Keyword(s):

Health Care ◽

Time Series ◽

Maternal Health ◽

Infant Mortality ◽

Moving Average ◽

Maternal Health Care ◽

The Sustainable Development ◽

Infant Deaths ◽

Moving Average Model ◽

The Impact

Infant mortality is an important marker of the overall society health. The 3rd goal of the Sustainable Development Goals aims at reducing infant deaths that occur due to preventable causes by 2030. Due to increased infant mortality the Kenyan government introduced Free Maternal Health Care as an intervention towards reducing infant mortality through elimination of the cost burden of accessing medical care by the mother and the infant. The study examines the impact of Free Maternal Health Care on infant mortality using Intervention time series analysis particularly the intervention Box Jenkins ARIMA (Autoregressive Integrated Moving Average) model. There was significant support that Free Maternal Health Care had a significant impact on infant mortality which was estimated to be a decrease of 10.15% in infant deaths per month.

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INTERCAMBIO TRASFRONTERIZO DE SERVICIOS DE SALUD Y MEDICINAS EN LA REGIÓN DE TIJUANA Y SAN DIEGO

Revista Pueblos y fronteras digital ◽

10.22201/cimsur.18704115e.2010.10.153 ◽

2010 ◽

Vol 5 (10) ◽

pp. 303

Author(s):

José G. Vargas-Hernández

Keyword(s):

Health Care ◽

Health Services ◽

Regional Development ◽

San Diego ◽

Negative Consequences ◽

Review Of The Literature ◽

Border Area ◽

Future Studies ◽

Documentary Analysis ◽

The Impact

Este trabajo tiene por objetivo analizar el intercambio fronterizo en la región Tijuana-San Diego de los servicios de atención médica, cuidados de la salud y medicamentos. Aun con un gran número de investigaciones y estudios, todavía se tienen muchos cuestionamientos con respecto al impacto de este intercambio en el desarrollo regional. El método empleado es exploratorio, analítico documental y de revisión de la literatura existente. En este trabajo se delimita el mercado trasfronterizo del sur de California y la zona fronteriza de Tijuana, las motivaciones de los usuarios y compradores, las principales barreras, características y tipología. Se enuncian algunas de las áreas para futuras investigaciones y finalmente se formulan algunas propuestas que tienen implicaciones en las políticas públicas. Este estudio arroja luz sobre la posibilidad de elevar los ingresos provenientes del comercio de los servicios de salud, mejorar la satisfacción de los usuarios y consumidores y mitigar las consecuencias negativas asociadas con el diseño de políticas y de iniciativas en los ámbitos multilateral, binacional, regional. ABSTRACTThe objective of this article is to analyze the border exchange in the Tijuana-San Diego region of medical services, health care and medicines. Despite the numerous research studies conducted, there are still many questions regarding the impact from this exchange on regional development. The exploratory method, documentary analysis and a review of the literature were utilized. This article is focused on the transboundary market of southern California and the Tijuana border area, the motivations of users and buyers, the main barriers, characteristics and typology. Some areas for future studies are specified, and lastly, some proposals with implications for public policies are formulated. This study sheds light on the possibilities of increasing income from commerce in health services, improving the satisfaction of users and consumers, and mitigating the negative consequences associated with the design of policies and initiatives at the multilateral, binational and regional levels.

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Looking at the bigger picture: effect of performance-based contracting of district health services on equity of access to maternal health services in Zambia

Health Policy and Planning ◽

10.1093/heapol/czz130 ◽

2019 ◽

Author(s):

Collins Chansa ◽

Mulenga Mary Mukanu ◽

Chitalu Miriam Chama-Chiliba ◽

Mpuma Kamanga ◽

Nicholas Chikwenya ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Health Expenditure ◽

Maternal Health Services ◽

Health Facilities ◽

District Level ◽

Health Service Provision ◽

Equity Of Access ◽

The Impact

Abstract Zambia has been using output-based approaches for over two decades to finance whole or part of the public health system. Between 1996 and 2006, performance-based contracting (PBC) was implemented countrywide with the Central Board of Health (CBoH) as the provider of health services. This study reviews the association between PBC and equity of access to maternal health services in Zambia between 1996 and 2006. A comprehensive document review was undertaken to evaluate the implementation process, followed by a trend analysis of health expenditure at district level, and a segmented regression analysis of data on antenatal care (ANC) and deliveries at health facilities that was obtained from five demographic and health survey datasets (1992, 1996, 2002, 2007 and 2014). The results show that PBC was anchored by high-level political support, an overarching policy and legal framework, and collective planning and implementation with all key stakeholders. Decentralization of health service provision was also an enabling factor. ANC coverage increased in both the lower and upper wealth quintiles during the PBC era, followed by a declining trend after the PBC era in both quintiles. Further, the percentage of women delivering at health facilities increased during the PBC era, particularly in rural areas and among the poor. The positive trend continued after the PBC era with similar patterns in both lower and upper wealth quintiles. Despite these gains, per capita health expenditure at district level declined during the PBC era, with the situation worsening after the PBC era. The study concludes that a nationwide PBC approach can contribute to improved equity of access to maternal health services and that PBC is a cost-efficient and sustainable policy reform. The study calls for policymakers to comprehensively evaluate the impact of health system reforms before terminating them.

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