International Journal of Health Policy and Management

International Journal of Health Policy and Management

Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services

Document Type : Original Article

Authors
Hema Bhatt 1
Suresh Tiwari 2
Tim Ensor 3
Dhruba Raj Ghimire 2
Tania Gavidia 4
1 Oxford Policy Management/NHSSP, Kathmandu, Nepal
2 Oxford Policy Management, Kathmandu, Nepal
3 University of Leeds, Leeds, UK
4 Volunteer VSO, Nepal
10.15171/ijhpm.2018.01
Abstract
Background
Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In 2005, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In 2009, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (4 ANC) visits and institutional deliveries in Nepal.

 
Methods
Demographic and health survey data from 1996, 2001, 2006 and 2011 were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of 4 ANC visits and institutional delivery services.

 
Results
Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of 4 ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in 2005, women were three times (adjusted odds ratio [AOR] = 3.020, P < .001) more likely to attend 4 ANC visits than when there was no FDC policy. After the implementation of Aama programme in 2009, the likelihood of attending 4 ANC visits increased six-folds (AOR = 6.006, P < .001) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR = 2.117, P < .001) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR = 5.116, P < .001) after the implementation of Aama compared to no FDC policy.

 
Conclusion
Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of 4 ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services without adequately considering the individual and community level factors
Keywords
Free Delivery Policies
Institutional Delivery
ANC Visits
Subjects

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International Journal of Health Policy and Management
Volume 7, Issue 7
2018
Pages 645-655

  • Received Date 02 December 2016
  • Revised Date 28 December 2017
  • Accepted Date 06 January 2018
  • First Published Date 01 July 2018
  • Published Date 01 July 2018