User fee exemptions and equity in access to caesarean sections: an analysis of patient survey data in Mali
- Marianne El-KhouryAffiliated withAssociate/Economist, Abt Associates Inc Email author
- , Laurel HattAffiliated withSenior Associate/Health Economist, Abt Associates Inc
- , Timothee GandahoAffiliated withSenior Advisor & Team Leader, Abt Associates
Little rigorous evidence exists on how health service utilization varies across socioeconomic groups after a user fee exemption policy has been implemented, and the evidence that does exist is mixed. In this paper, we estimate the distribution of caesarean section deliveries across socioeconomic groups following Mali’s implementation of a fee exemption policy for caesareans in 2005.
We conducted a patient survey in 2010 to collect socioeconomic data from 2,477 women who had caesareans in a representative sample of 25 facilities across all regions of Mali. We used these data along with data from the most recent Demographic and Health Survey to construct a wealth index and classify women into population-based wealth groupings. We compared the wealth distribution of women delivering via caesarean section to that of a nationally representative sample of women giving birth.
We found that wealthier women make up a disproportionate share of those having free caesareans, five years after implementation of the fee exemption policy. Women in the richest two quintiles accounted for 58 percent of all caesareans, while women in the poorest two quintiles accounted for 27 percent of all caesareans. Fewer women in the poorest two-fifths of the population are receiving caesareans than what we would expect given their share in the population of women giving birth.
While fee exemptions remove important financial barriers to accessing priority maternal health services, they are insufficient to ensure equal access among wealth groups.
KeywordsUser fees Equity Caesarean sections Mali Access
- User fee exemptions and equity in access to caesarean sections: an analysis of patient survey data in Mali
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
International Journal for Equity in Health
- Online Date
- August 2012
- Online ISSN
- BioMed Central
- Additional Links
- User fees
- Caesarean sections
- Author Affiliations
- 1. Associate/Economist, Abt Associates Inc, 4550 Montgomery Ave, Suite 800 North, Bethesda, MD, 20814, USA
- 2. Senior Associate/Health Economist, Abt Associates Inc, 4550 Montgomery Ave, Suite 800 North, Bethesda, MD, 20814, USA
- 3. Senior Advisor & Team Leader, Abt Associates, Bamako, MALI