The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi

This study evaluated the effect of user fee exemption on the utilization of maternal health services

Gerald Manthalu


Scholarcy highlights

  • Since the late 1990s, many low and middle countries have abolished user fees for health care or put in place exemption mechanisms in order to expand access to health care
  • This article asks whether user fee exemption at Christian Health Association of Malawi health facilities with service level agreements has led to increased utilization of antenatal, delivery and postpartum care at these facilities
  • In model, the coefficient on the SLA dummy shows that the mean proportion of women who made at least one antenatal care visits during pregnancy increased by 15% due to user fee exemption
  • User fee exemption at CHAM health facilities with SLAs led to an increase in the proportion of pregnant women who made at least one ANC visit during pregnancy, average ANC visits and deliveries while it had no effect on first ANC visits in the first trimester and postpartum care visits
  • This implies that, while user fee exemption is an important strategy for increasing maternal health care utilization, it may not have the same importance for different maternal health services
  • We recommend that user fee exemption be expanded to more eligible CHAM health facilities to increase utilization of the price-elastic services while the effects of other determinants such as cultural norms, risk attitudes, quality of maternal health care and health worker attitudes should be evaluated for the services for which utilization was not responsive to price change

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