Examining the distribution of benefits of a free Maternal and Child Health programme in Enugu State, Nigeria: a benefit incidence analysis

  • Tropical Medicine and International Health, Volume 25, No. 12, Year 2020

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Study Justification:
– The study aims to determine the population groups that benefit from a Free Maternal and Child Health (FMCH) program in Enugu State, Nigeria.
– The goal is to understand the equity effects of the program and assess whether it has achieved its aim of enhancing access, particularly for the low-income population.
– By conducting a benefit incidence analysis (BIA), the study provides valuable insights into the distribution of benefits and the impact of out-of-pocket expenditures on the program’s effectiveness.
Highlights:
– The total gross benefit incidence of the FMCH program was ₦2.681 million ($7660).
– Urban dwellers consumed ₦1.581 million ($4517.1) of the gross benefits, while rural dwellers consumed ₦1.1 million ($3608.20).
– However, out-of-pocket expenditures for FMCH services exceeded the gross benefits, with ₦6,527,580 (US$18,650.2) in the urban area and ₦3,194,706 (US$9,127.7) among rural dwellers.
– There was no statistically significant difference in benefit incidence and out-of-pocket expenditure between urban and rural dwellers or across socio-economic groups.
Recommendations:
– Review the implementation of the FMCH program to address the negative benefit incidence caused by high out-of-pocket expenditures.
– Develop strategies to reduce out-of-pocket expenses and improve access to FMCH services, particularly for the low-income population.
– Consider reallocating resources to ensure that the program achieves its intended goal of providing equitable access to maternal and child health services.
Key Role Players:
– Policy makers and government officials responsible for the implementation and oversight of the FMCH program.
– Health professionals and service providers involved in delivering maternal and child health services.
– Community leaders and organizations that can advocate for improved access and reduced out-of-pocket expenditures.
– Researchers and academics who can provide expertise and guidance in evaluating and refining the program.
Cost Items for Planning Recommendations:
– Funding for the implementation of revised strategies to reduce out-of-pocket expenses, such as subsidizing FMCH services or expanding insurance coverage.
– Investment in training and capacity building for health professionals to ensure the effective delivery of maternal and child health services.
– Resources for community engagement and awareness campaigns to promote the benefits of the FMCH program and encourage utilization.
– Monitoring and evaluation costs to assess the impact of the revised strategies and track progress towards improved access and equity.
Please note that the cost items provided are general categories and not actual cost estimates. The specific budget items would depend on the context and priorities of the Enugu State government.

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Objective: To determine the population groups that benefit from a Free Maternal and Child Health (FMCH) programme in Enugu State, South-east Nigeria, so as to understand the equity effects of the programme. Method: A community-based survey was conducted in rural and urban local government areas (LGAs) to aid the benefit incidence analysis (BIA) of the FMCH. Data were elicited from 584 randomly selected women of childbearing age. Data on their level of utilisation of FMCH services and their out-of-pocket expenditures on various FMCH services that they utilised were elicited. Benefits of the FMCH were valued using the unit cost of providing services while the net benefit was calculated by subtracting OOP expenditures made for services from the value of benefits. Costs were calculated in local currency (Naira (₦)) and converted to US Dollars. The net benefits were disaggregated by urban–rural locations and socio-economic status (SES). Concentration indices were computed to provide the level of SES inequity in BIA of FMCH. Results: The total gross benefit incidence was ₦2.681 million ($7660). The gross benefit that was consumed by the urban dwellers was ₦1.581 million ($4517.1), while the rural dwellers consumed gross benefits worth ₦1.1 million ($3608.20). However, OOP expenditure for the supposedly FMCH was ₦6 527 580 (US$18 650.2) in the urban area, while it was ₦3, 194, 706 (US$ 9127.7) among rural dwellers. There was negative benefit incidence for the FMCH because the OOP exceeded the gross benefits at the point of use of services. There was no statistically significant difference in the benefit incidence and OOP expenditure between the urban and rural dwellers and across socio-economic groups. Conclusion: The distribution of the gross benefits of the FMCH programme indicates that it may not have achieved the desired aim of enhanced access particularly to the low-income population. Crucially, the high level of OOP erased whatever societal gain the FMCH was developed to provide. Hence, there is a need to review its implementation and re-strategise to reduce OOP and achieve greater access for improved effectiveness of the programme.

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The recommendation to improve access to maternal health based on the study “Examining the distribution of benefits of a free Maternal and Child Health programme in Enugu State, Nigeria: a benefit incidence analysis” is to review the implementation of the Free Maternal and Child Health (FMCH) program and re-strategize to reduce out-of-pocket (OOP) expenditures and achieve greater access for improved effectiveness.

The study found that although the FMCH program provided gross benefits, the OOP expenditures exceeded the value of benefits at the point of service utilization. This indicates that the program may not have achieved its aim of enhancing access, particularly for the low-income population. The high level of OOP expenses erased the societal gains intended by the FMCH program.

To address this issue, it is recommended to review the implementation of the program and identify ways to reduce OOP expenditures. This could involve exploring options such as increasing the coverage of services provided under the FMCH program, negotiating lower costs with healthcare providers, or implementing financial protection mechanisms to reduce the financial burden on individuals seeking maternal health services.

Additionally, re-strategizing the program should focus on ensuring equitable distribution of benefits across urban and rural areas, as well as different socio-economic groups. The study found no statistically significant difference in benefit incidence and OOP expenditures between urban and rural dwellers or across socio-economic groups. Therefore, efforts should be made to ensure that the FMCH program reaches and benefits those who need it the most, particularly the low-income population.

By implementing these recommendations, the FMCH program can be transformed into an innovation that improves access to maternal health services in Enugu State, Nigeria. This will contribute to better maternal and child health outcomes and promote equity in healthcare access.
AI Innovations Description
The recommendation to improve access to maternal health based on the study “Examining the distribution of benefits of a free Maternal and Child Health programme in Enugu State, Nigeria: a benefit incidence analysis” is to review the implementation of the Free Maternal and Child Health (FMCH) program and re-strategize to reduce out-of-pocket (OOP) expenditures and achieve greater access for improved effectiveness.

The study found that although the FMCH program provided gross benefits, the OOP expenditures exceeded the value of benefits at the point of service utilization. This indicates that the program may not have achieved its aim of enhancing access, particularly for the low-income population. The high level of OOP expenses erased the societal gains intended by the FMCH program.

To address this issue, it is recommended to review the implementation of the program and identify ways to reduce OOP expenditures. This could involve exploring options such as increasing the coverage of services provided under the FMCH program, negotiating lower costs with healthcare providers, or implementing financial protection mechanisms to reduce the financial burden on individuals seeking maternal health services.

Additionally, re-strategizing the program should focus on ensuring equitable distribution of benefits across urban and rural areas, as well as different socio-economic groups. The study found no statistically significant difference in benefit incidence and OOP expenditures between urban and rural dwellers or across socio-economic groups. Therefore, efforts should be made to ensure that the FMCH program reaches and benefits those who need it the most, particularly the low-income population.

By implementing these recommendations, the FMCH program can be transformed into an innovation that improves access to maternal health services in Enugu State, Nigeria. This will contribute to better maternal and child health outcomes and promote equity in healthcare access.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Data Collection: Conduct a community-based survey in Enugu State, Nigeria, targeting both rural and urban areas. Randomly select a sample of women of childbearing age and collect data on their utilization of maternal health services and out-of-pocket expenditures.

2. Valuation of Benefits: Determine the value of benefits provided by the Free Maternal and Child Health (FMCH) program by calculating the unit cost of providing services. This can be done by analyzing the cost data from healthcare providers and estimating the value of services received by each participant.

3. Calculation of Net Benefits: Calculate the net benefits by subtracting the out-of-pocket expenditures made by the participants for maternal health services from the value of benefits received. This will provide an estimate of the actual benefits gained by the participants after accounting for their financial contributions.

4. Disaggregation of Results: Disaggregate the net benefits by urban and rural locations, as well as socio-economic status (SES). This will allow for an analysis of the distribution of benefits across different population groups and the identification of any inequities.

5. Calculation of Concentration Indices: Compute concentration indices to measure the level of socio-economic inequity in the benefit incidence analysis of the FMCH program. This will provide insights into whether the program is reaching and benefiting the low-income population as intended.

6. Comparison of Results: Compare the results of the simulation with the findings from the original study to assess the impact of the recommended changes. Analyze any changes in benefit incidence, out-of-pocket expenditures, and socio-economic inequities to determine the effectiveness of the proposed strategies.

By following this methodology, policymakers and stakeholders can gain a better understanding of the potential impact of the recommendations on improving access to maternal health services in Enugu State, Nigeria. This information can then be used to inform decision-making and guide the implementation of changes to the FMCH program.

Statistics:
Citations: 2
Authors: 7
Identifiers:
DOI: 10.1111/tmi.13486
ISSN: 13602276
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Nigeria
Study Design:
Cohort Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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