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Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review

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Banke-Thomas, Aduragbemi, Ayomoh, Francis Ifeanyi, Omolade Abejirinde, Ibukun-Oluwa, Banke-Thomas, Oluwasola, Eboreime, Ejemai Amaize and Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605 (2020) 'Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review'. International Journal of Health Policy Management. (In Press)

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Abstract

Background
Cost is a major barrier to maternal health service utilisation for many women in low- and middle-income countries (LMICs). However, comparable evidence of the available cost data in these countries is limited. We conducted a systematic review and comparative analysis of costs of utilising maternal health services in these settings.

Methods
We searched peer-reviewed and grey literature databases for articles reporting cost of utilising maternal health services in LMICs published post-2000. All retrieved records were screened and articles meeting the inclusion criteria selected. Quality assessment was performed using the relevant cost-specific criteria of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. To guarantee comparability, disaggregated costs data were inflated to 2019 US dollar equivalents. Total adjusted costs and cost drivers associated with utilising each service were systematically compared. Where heterogeneity in methods or non-disaggregated costs was observed, narrative synthesis was used to summarise findings.

Results
Thirty-six studies met our inclusion criteria. Many of the studies costed multiple services. However, the most frequently costed services were utilisation of normal vaginal delivery (22 studies), caesarean delivery (13), and antenatal care (ANC) (10). The least costed services were post-natal care (PNC) and post-abortion care (PAC) (5 each). Studies used varied methods for data collection and analysis and their quality ranged from low to high with most assessed as average or high. Generally, across all included studies, cost of utilisation progressively increased from ANC and PNC to delivery and PAC, and from public to private providers. Medicines and diagnostics were main cost drivers for ANC and PNC while cost drivers were variable for delivery. Women experienced financial burden of utilising maternal health services and also had to pay some unofficial costs to access care, even where formal exemptions existed.

Conclusion
Consensus regarding approach for costing maternal health services will help to improve their relevance for supporting policy-making towards achieving universal health coverage. If indeed the post-2015 mission of the global community is to “leave no one behind,” then we need to ensure that women and their families ar

Item Type: Article
Subjects: W General Medicine. Health Professions > W 74 Medical economics. Health care costs
W General Medicine. Health Professions > W 20.5 Biomedical research
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.34172/ijhpm.2020.104
Depositing User: Tina Bowers
Date Deposited: 02 Jul 2020 12:59
Last Modified: 03 Aug 2020 10:15
URI: https://archive.lstmed.ac.uk/id/eprint/14889

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