Should expectant women be incentivized to deliver at hospitals?

In a poor country such as Malawi, achieving desired maternal and neonatal standards has always been problematic despite several interventions by both government and the private sector.

Obviously, poverty, poor infrastructure, inaccessibility of health care services, traditional beliefs and practices are some of the major reasons for the high levels of maternal and neo-natal mortality and these factors often result in women opting against delivering in hospitals.

Having realised that hitherto applied approaches are not yielding required results, the Ministry of Health, with support from a local private partner, is implementing Result Based Financing (RBF). This is an incentivised approach which addresses the supply and demand side challenges in the maternal and neo-natal health care provision.

In short, women who deliver at health centres are given a financial contribution to cater for their upkeep as well as transport back home.

However, opponents of the initiative, who ironically include health workers, doubt that it can improve health care utilisation, coverage and even service delivery. In certain areas it is already attracting a lot of negative debates with others labelling it ‘satanic’.

Reagan Kaluluma, deputy programme director for RBF-Options, a local NGO that has partnered the ministry in implementing the initiative, says the answer to all the above questions is positive.

“Let me state from the outset that success is being demonstrated by measurable reductions in morbidity and mortality. The idea is workable and was hatched after recognising that there are barriers that prevent women from going to health centres for deliveries which include cost of transport and costs associated with staying there. This is why we provide a financial contribution of between K3 000 and K5 000.

“We use appropriate health workers to enable primary beneficiaries to access information regarding participating such as transport to and from health facilities. People must understand that the survival of mothers and newborns and even children is strongly influenced by their access to adequate health services before and after birth,” he explains.

But retired clinical officer Charles Vinani of Dowa feels that the focus on financial incentives can have damaging effects.

“Financial incentives aren’t the only causal factor for enhanced health care. This emphasis on financial incentives is self-defeatist and can also increase the likelihood of distorted information where people could think they are being rewarded for bearing more children. It will also encourage the dependency syndrome on top of presenting a huge strain on the already overstretched health personnel,” Vinani observes.