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Observational Study
. 2021 Jan 28;21(1):99.
doi: 10.1186/s12913-021-06107-x.

The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

Corinna Vossius  1 , Estomih Mduma  2   3   4 , Robert Moshiro  2   4   5 , Paschal Mdoe  2   4 , Jan Terje Kvaløy  3   6 , Hussein Kidanto  3   7 , Sara Lyanga  2 , Hege Ersdal  8   4
Affiliations
Observational Study

The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

Corinna Vossius et al. BMC Health Serv Res. .

Abstract

Background: Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees.

Methods: Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes.

Results: A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently with a decrease of about 17/1000 births in non-cephalic presentations. Labour complications and caesarean sections increased with about 80/1000 births. There was a reduction in newborns with birth weight less than 2500 g. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks.

Conclusion: After the introduction of ambulance and delivery fees, an increase in labour complications and caesarean sections and a decrease in newborns with low birthweight were observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.

Keywords: Birth attendance; Delivery fees; Labour complications; Low resource setting; Maternal health; Newborn health; Perinatal survival; Pregnancy complications.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Variable Life Adjusted Display (VLAD) plots presenting cumulative excess of indicators with increasing numbers in the post-introduction period
Fig. 2
Fig. 2
Variable Life Adjusted Display (VLAD) plots presenting the cumulative deficiency of indicators with decreasing numbers in the post-introduction period
Fig. 3
Fig. 3
Cumulative sums (CUSUM) of indicators with increasing numbers in the post-introduction period
Fig. 4
Fig. 4
Cumulative sums (CUSUM) of indicators with decreasing numbers in the post-introduction period
See this image and copyright information in PMC

References

    1. Transforming our World: The 2030 Agenda for Sustainable Development United Nations, 2015. https://sustainabledevelopment.un.org/index.php?page=view&type=400&nr=21.... Accessed 24 March 2020.
    1. Graham WJ, Bell JS, Bullough CH. Can skilled attendance at delivery reduce maternal mortality in developing countries. Safe Motherhood Strategies. 2001;17:97–130.
    1. Mduma ER, Gratz J, Patil C, Matson K, Dakay M, Liu S, et al. The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Study (MAL-ED): Description 5 of the Tanzanian Site. Clin Infect Dis. 2014;59(Issue suppl_4):S325–S330. doi: 10.1093/cid/ciu439. - DOI - PubMed
    1. Tanzania Demographic and Health Surveys 2015-2016 https://dhsprogram.com/publications/publication-fr321-dhs-final-reports.cfm. Accessed 24 March 2020.
    1. Msemo G, Massawe A, Mmbando D, Mwizamuholya D, Ersdal HL, Perlman J. Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training. Pediatrics. 2013;131:353–360. doi: 10.1542/peds.2012-1795. - DOI - PubMed

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