Health Economics

An Assessment of Domestic Financing for Reproductive, Maternal, Neonatal and Child Health in Sub-Saharan Africa: Potential Gains and Fiscal Space

jnovignon — Fri, 13 Sep 2019 17:58:49 +0000

An Assessment of Domestic Financing for Reproductive, Maternal, Neonatal and Child Health in Sub-Saharan Africa: Potential Gains and Fiscal Space jnovignon Fri, 09/13/2019 - 17:58

Background

Reproductive, maternal, neonatal and child health (RMNCH) remains an important public health objective. In sub-Saharan Africa (SSA), inadequate financial commitment continues to pose a major challenge to improving RMNCH outcomes. Understanding financing gains and potential fiscal space for RMNCH can therefore not be overemphasized.

Objective

This study sought to analyse the potential gains from increased domestic financing as a source for improving RMNCH outcomes in SSA. We also assessed, in addition to the potential gains, the potential fiscal space available for financing RMNCH in SSA.

Methods

Our study used panel econometric techniques to estimate gains from increased health financing in terms of RMNCH. We also reviewed tax system performance as well as debt sustainability to identify fiscal space potentials across countries.

Results

We found significant gains from both domestic and external financing. The estimated elasticities suggest that the gains from domestic public financing were much stronger. The fiscal space options identified include tax revenue performance improvements, improved public financial management, and borrowing, at least in the short to medium term. The results show that fiscal space from improved tax systems ranged from US$34.6 per capita in Uganda to US$310.6 per capita in Nigeria.

Conclusion

This result reinforces calls for increased domestic financing for health through innovations in domestic resource mobilization. Improving the performance of tax systems will be a step in the right direction, with possible long-term gains to the health sector.

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Childhood mortality, intra-household bargaining power and fertility preferences among women in Ghana

jnovignon — Fri, 13 Sep 2019 17:56:05 +0000

Childhood mortality, intra-household bargaining power and fertility preferences among women in Ghana jnovignon Fri, 09/13/2019 - 17:56

Background

Continuing population growth could be detrimental for social and economic wellbeing. Understanding the factors that influence family planning decisions will be important for policy. This paper examines the effect of childhood mortality and women’s bargaining power on family planning decisions.

Methods

Data was from the 2014 Ghana Demographic and Health Survey (DHS). A sample of 3313 women in their reproductive age were included in this study. We created variables on women’s exposure to and experience of child mortality risks. Three different indicators of women’s bargaining power in the household were also used. Probit models were estimated in accordance with the nature of the dependent variable.

Results

Results from the probit models suggest that child mortality has a positive association with higher fertility preference. Also, child mortality risks and woman’s bargaining power play important roles in a woman’s fertility choices in Ghana. Women with higher bargaining power were likely to prefer fewer children in the face of child mortality risks, compared to women with lower bargaining power.

Conclusion

In addition to public sensitization campaigns on the dangers of high fertility and use of contraceptives, the findings of this study emphasize the need to focus on reducing child mortality and improving women bargaining power in developing countries.

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Socioeconomic inequalities in maternal health care utilization in Ghana

jnovignon — Fri, 13 Sep 2019 17:47:25 +0000

Socioeconomic inequalities in maternal health care utilization in Ghana jnovignon Fri, 09/13/2019 - 17:47

BACKGROUND:

Improving maternal and child health remains a public health priority in Ghana. Despite efforts made towards universal coverage, there are still challenges with access to and utilization of maternal health care. This study examined socioeconomic inequalities in maternal health care utilization related to pregnancy and identified factors that account for these inequalities.

METHODS:

We used data from three rounds of the Ghana Demographic and Health Surveys (2003, 2008 and 2014). Two health care utilization measures were used; (i) four or more antenatal care (ANC) visits and (ii) delivery by trained attendants (DTA). We first constructed the concentration curve (CC) and estimated concentration indices (CI) to examine the trend in inequality. Secondly, the CI was decomposed to estimate the contribution of various factors to inequality in these outcomes.

RESULTS:

The CCs show that utilization of at least four ANC visits and DTA were concentrated among women from wealthier households. However, the trends show the levels of inequality decreased in 2014. The CI of at least four ANC visits was 0.30 in 2003 and 0.18 in 2014. Similarly, the CIs for DTA was 0.60 in 2003 and 0.42 in 2014. The decomposition results show that access to National Health Insurance Scheme (NHIS) and women's education levels were the most important contributors to the reduction in inequality in maternal health care utilization.

CONCLUSIONS:

The findings highlight the importance of the NHIS and formal education in bridging the socioeconomic gap in maternal health care utilization.

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Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: a decomposition analysis

jnovignon — Tue, 13 Aug 2019 17:28:58 +0000

Measuring and explaining changing patterns of inequality in institutional deliveries between urban and rural women in Ghana: a decomposition analysis jnovignon Tue, 08/13/2019 - 17:28

Abstract

Background: Despite recent progress in improving access to maternal health services, the utilization of these services remains inequitable among women in developing countries, and rural women are particularly disadvantaged. This study sought to measure i) disparities in the rates of institutional births between rural and urban women in Ghana, ii) the extent to which existing disparities are due to differences in the distribution of the determinants of institutional delivery between rural and urban women, and iii) the extent to which existing disparities are due to discrimination in resource availability.

Methods: Using Demographic and Health Survey data from 2003, 2008, and 2014, this study decomposed inequalities in institutional delivery rates among urban and rural Ghanaian woman using the Oaxaca, the Blinder, and related decompositions for non-linear models. The determinants of the observed inequalities were also analyzed.

Results: Institutional delivery rates in urban areas exceeded those of rural areas by 32.4 percentage points due to differences in distribution of the determinants of institutional delivery between the two areas. The main determinants driving the observed disparities were wealth, which contributed to about 16.1% of the gap, followed by education level, and number of antenatal visits.

Conclusion: Relative to urban women, rural women have lower rates of institutional deliveries due primarily to lower levels of wealth, which results in financial barriers in accessing maternal health services. Economic empowerment of rural women is crucial in order to close the gap in institutional delivery between urban and rural women.

Full paper available at the link below

https://equityhealthj.biomedcentral.com/track/pdf/10.1186/s12939-019-1025-z

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