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User fees and maternity services in Ethiopia
Luwei Pearson1, Meena Gandhi, Keseteberhan Admasu
1UNICEF, Ethiopia. lpearson@unicef.org
Summary
Maternal health service use is low in Ethiopia, with most facilities charging fees despite a ban. Facilities charging fees offered better services, but cost remains a barrier to care.
Area of Science:
- Public Health
- Health Services Research
- Maternal Health
Background:
- Maternal health service utilization in Ethiopia is critically low.
- A government decree prohibits user fees for maternity services, yet many facilities charge patients.
- Understanding the impact of user fees on service provision and quality is essential.
Purpose of the Study:
- To investigate user fees for maternity services in Ethiopia.
- To analyze the relationship between user fees and the provision, quality, and utilization of maternity care.
Main Methods:
- A national assessment of emergency obstetric and newborn care (EmONC) was conducted in 2008.
- User fees for maternity services were examined in 751 health facilities providing childbirth services.
- Data on facility characteristics, service provision, and costs were collected.
Main Results:
- Only 6.6% of women gave birth in health facilities.
- Despite the ban, 68% of facilities charged for normal delivery and 65% charged for some aspect of care.
- Facilities charging fees had more beds, higher delivery volumes, treated more complications, and had more skilled birth attendants.
- Hospitals charging fees had a lower case fatality rate (3.8%) compared to those not charging (7.1%).
Conclusions:
- Low utilization of maternal health services persists in Ethiopia.
- User fees, though prohibited, are common and may be linked to better service provision due to lack of government reimbursement.
- Out-of-pocket expenses beyond facility fees, such as transport and accommodation, also hinder access.
- Quality of care must be considered in policy discussions regarding user fees for maternity services.
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