背景:全民健康覆盖(UHC)的概念包括获得基本卫生服务和免受经济损害的自由。世界卫生组织的孕产妇新生儿和青少年健康政策调查(MNCAH)收集了有可能降低孕产妇发病率和死亡率的政策数据。指标,“下列保健服务是否在公共部门的使用点免费为育龄妇女提供?”免费提供13个关键类别的孕产妇健康相关服务,衡量在孕产妇健康方面实施UHC的成功。然而,尚不清楚它是否提供了提供免费护理的有效措施。因此,这项研究将三个国家的免费孕产妇保健法律和政策与实际做法进行了比较.
结果:我们在阿根廷的四个区/省进行了横断面研究,加纳,和印度。我们进行了案头审查,以确定国家一级的免费护理法律和政策,并将其与全球一级的报告进行比较。我们对15-49岁使用部件服务的女性或其陪同人员进行了离职采访,以及设施首席财务官或计费管理员,以确定妇女是否有与获得服务相关的自付支出。对于指定的免费服务,计算了妇女服务级别的支出流行率,并计算了财务人员报告中曾经有与指定为免费服务相关的支出的妇女。这三个数据来源(案头审查,对妇女和管理人员的调查)进行了三角测量,并进行了卡方分析,以确定费用是否由标准权益分层者不同地征收。将服务指定为免费服务与MNCAH对阿根廷和加纳的政策调查中的报告相符。在印度,杀虫剂处理过的蚊帐以及梅毒的测试和治疗仅被指定为对选定的人群免费,与世卫组织MNCAH政策调查不同。在阿根廷接受采访的1046、923和1102名妇女和陪同人员中,加纳,印度,分别,在阿根廷,在每种情况下接受成分服务的妇女中,相关支出的患病率最高的是剖宫产(26%,24/92);加纳的计划生育(78.4%,69/88);印度的产后产妇护理(94.4%,85/90)。在阿根廷,财政官员报告的与获得任何免费服务相关的自付支出的妇女比例最高,为9.1%(2/22),加纳64.1%(93/145),和29.7%(47/158)在印度。在这三个国家,自付费用的自我报告与地区/省和妇女的教育状况显着相关。此外,阿根廷的财富五分之一和印度的年龄与报告自付支出的女性显着相关。
结论:全球MNCAH政策数据库中基本准确地报道了免费护理法。值得注意的是,我们发现,妇女吸收了直接和间接成本,并为指定为免费的服务支付了正式和非正式的费用。因此,策略指示符在三种设置中不提供UHC的有效反映。
BACKGROUND: The concept of universal health coverage (UHC) encompasses both access to essential health services and freedom from financial harm. The World Health Organization\'s Maternal Newborn Child and Adolescent Health (MNCAH) Policy Survey collects data on policies that have the potential to reduce maternal morbidity and mortality. The indicator, \"Are the following health services provided free of charge at point-of-use in the public sector for women of reproductive age?\", captures the free provision of 13 key categories of maternal health-related services, to measure the success of UHC implementation with respect to maternal health. However, it is unknown whether it provides a valid measure of the provision of free care. Therefore, this
study compared free maternal healthcare laws and policies against actual practice in three countries.
RESULTS: We conducted a cross-sectional
study in four districts/provinces in Argentina, Ghana, and India. We performed desk reviews to identify free care laws and policies at the country level and compared those with reports at the global level. We conducted exit interviews with women aged 15-49 years who used a component service or their accompanying persons, as well as with facility chief financial officers or billing administrators, to determine if women had out-of-pocket expenditures associated with accessing services. For designated free services, prevalence of expenditures at the service level for women and reports by financial officers of women ever having expenditures associated with services designated as free were computed. These three sources of data (desk review, surveys of women and administrators) were triangulated, and chi-square analysis was conducted to determine if charges were levied differentially by standard equity stratifiers. Designation of services as free matched what was reported in the MNCAH Policy Survey for Argentina and Ghana. In India, insecticide-treated bed nets and testing and treatment for syphilis were only designated as free for selected populations, differing from the WHO MNCAH Policy Survey. Among 1046, 923, and 1102 women and accompanying persons who were interviewed in Argentina, Ghana, and India, respectively, the highest prevalence of associated expenditures among women who received a component service in each setting was for cesarean section in Argentina (26%, 24/92); family planning in Ghana (78.4%, 69/88); and postnatal maternal care in India (94.4%, 85/90). The highest prevalence of women ever having out of pocket expenditures associated with accessing any free service reported by financial officers was 9.1% (2/22) in Argentina, 64.1% (93/145) in Ghana, and 29.7% (47/158) in India. Across the three countries, self-reports of out of pocket expenditures were significantly associated with district/province and educational status of women. Additionally, wealth quintile in Argentina and age in India were significantly associated with women reporting out of pocket expenditures.
CONCLUSIONS: Free care laws were largely accurately reported in the global MNCAH policy database. Notably, we found that women absorbed both direct and indirect costs and made both formal and informal payments for services designated as free. Therefore, the policy indicator does not provide a valid reflection of UHC in the three settings.