Does healthcare voucher provision improve utilisation in the continuum of maternal care for poor pregnant women? Experience from Bangladesh

Figures & data

Table 1. Benefit package of MHVS.

Description of Services	Reimbursement to provider (BDT)	Incentive to beneficiaries
Registration of an eligible woman	20
ANC: Two blood and 2 urine tests	(35x4) = 140	Free service
Three ANC check-ups (at facility)	(50x3) = 150	Free service+ transportation (BDT 300 for 3 visits)
One PNC check-up (at facility)	50	Free service+ transportation (BDT 100)
Normal delivery	300	BDT 2000 (at facility)/BDT 500 (home with CSBA) + transportation (BDT 100)
Medicines	100	Free medicine
Forceps delivery, manual removal of placenta, dilation and curettage, or vacuum extraction	1000	Free service + emergency transportation to referral facility, if needed (ceiling BDT 500)
Medicines for management of eclampsia	1000
C-section and medicine	6000	BDT 2000 (qualified provider).

Except for medicines and registration incentives, 50% of provider reimbursement goes to a ‘seed fund’ used to improve the quality of care at the facility. The remaining 50% is distributed among people directly involved in providing services. This does not apply to private facilities where providers receive full reimbursement.

Table 2. ANC, delivery, and PNC use among the different utilisation clusters, 2017.

Variables	Category	Cluster 1 (High utilisation 22.9%) % (n)	Cluster 2 (High utilisation, except ANC 6.1%) % (n)	Cluster 3 (Sufficient ANC, else low 37.3%) % (n)	Cluster 4 (Overall low utilisation 33.3%) % (n)
Voucher receipt (n = 2400)***	Yes	43.5 (199)	5.0 (23)	41.7 (191)	9.8 (44)
	No	15.4 (299)	6.5 (127)	36.2 (703)	41.9 (814)
ANC (n = 2400)**	3 or more	37.9 (510)	0.00 (0)	62.1 (835)	0.00 (0)
	1–2	0.0 (0)	18.9 (113)	0.0 (0)	81.0 (484)
	None	0.0 (0)	9.6 (44)	1.1 (5)	89.1(408)
Skilled birth attendant(n = 2400)**	Yes	49.9(519)	13.3 (139)	27.1(282)	9.6 (99)
	No	0.0 (0)	0.0 (0)	46.6 (634)	53.4 (726)
Facility birth(n = 2400)**	Yes	74.1 (519)	19.8 (139)	4.9 (34)	1.1 (8)
	No	0.0 (0)	0.0 (0)	52.3 (889)	47.6 (810)
Had a postnatal check within 2 weeks (n = 2400)**	Yes	58.1 (531)	15.5 (142)	21.0 (192)	5.3 (49)
	No	0.0 (0)	0.0 (0)	48.5 (720)	51.5 (765)
Socioeconomic status (n = 2400)***	Highest quintile (better-off)	41.8 (221)	9.6(51)	35.9 (190)	12.5 (66)
	4^th Quintile	27.7 (96)	6.5 (23)	38.3 (132)	27.3 (94)
	3^rd quintile	16.7 (97)	5.8(34)	39.0(227)	38.3(233)
	2^nd quintile	17.8(85)	3.7(19)	41.0(159)	37.3(251)
	lowest quintile (poorest)	8.3(39)	4.1(19)	33.8(159)	53.6(251)
Age group of mothers (n = 2400)***	Under 20	22.1(50)	4.9(11)	40.3(90)	32.6 (73)
	20–24	27.8 (213)	6.3 (49)	38.0(292)	27.8 (213)
	25–29	22.4 (160)	5.4 (38)	37.6(268)	34.5(246)
	30–34	21.4(103)	6.7(32)	35.8(172)	35.8(172)
	35 and more	9.0 (20)	8.2 (18)	36.8 (80)	45.8 (99)
Education of mothers*** (n = 2400)	Illiterate	11.6 (75)	3.7 (24)	36.1 (233)	48.4 (312)
	Primary	167 (16.9)	7.1 (70)	39.5 (391)	36.4 (360)
	Secondary	36.6 (251)	6.9 (47)	37.8 (259)	18.5 (127)
	Higher secondary	62.1(52)	5.4 (5)	29.7 (25)	2.7 (2)
	Graduate	80.0 (19)	6.6 (1)	6.6 (1)	6.6 (1)
Distance to health facility (n = 2400)***	Municipality (city center)	20.4 (23)	8.4 (9)	26.5 (29)	44.5 (49)
	Non-municipality but within 5km of health facility	35.9 (157)	5.5 (24)	37.5 (164)	20.9 (91)
	Non-municipality and beyond 5km of health facility	19.1 (355)	6.1 (114)	38.4 (712)	36.2 (672)
Birth order of current birth (n = 2400)***	1	31.8 (232)	6.5 (48)	39.5 (288)	22.0 (161)
	2	25.0 (175)	5.9 (41)	35.2 (245)	33.9 (236)
	3	20.3 (93)	8.2 (37)	40.1 (184)	31.4 (143)
	4	12.4 (32)	4.8 (12)	38.2 (99)	44.6 (116)
	≥5	6.3 (16)	3.4 (9)	34.1 (86)	56.3 (143)

***significant at 5% level. **significant at 10% level.

Figure 1. Cluster profile for 4 clusters solution by care utilisation pattern.

Figure 2. Predicted probabilities of cluster membership within all women.

Figure 3. Predicted probabilities of cluster membership for bottom 2 asset quintiles.

Data availability statement

The authors confirm that all data underlying the findings in this paper are freely available upon request subject to the adherence to icddr,b’s data sharing policy (http://www.icddrb.org/policies). The request for the data can be sent to [email protected], the Principal Investigator of the project.