ArticleHealth policy and planning2016
The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.
Article in Health policy and planning, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 3 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A systematic review of the effect of performance-based financing interventions on out-of-pocket expenses to improve access to, and the utilization of, maternal health services across health sectors in sub-Saharan Africa.Journal of global health · 2023Pooled it
- Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review.Global health promotion · 2020Pooled it
- Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review.BMJ open · 2019Pooled it
- Conditional Cash Transfers Improve Retention in PMTCT Services by Mitigating the Negative Effect of Not Having Money to Come to the Clinic.Journal of acquired immune deficiency syndromes (1999) · 2017Trial
- Impact of Ghana's fee exemption policy on maternal health service utilisation: an inverse probability of treatment weighting analysis of pooled national data.Journal of global health · 2025Article
- Utilization of maternal health facilities and rural women's well-being: towards the attainment of sustainable development goals.Health economics review · 2024Article
- Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review.PLOS global public health · 2024Article
- Effectiveness of the Gratuité user fee exemption policy on utilization and outcomes of maternal, newborn and child health services in conflict-affected districts of Burkina Faso from 2013 to 2018: a pre-post analysis.Conflict and health · 2023Article
- User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.ClinicoEconomics and outcomes research : CEOR · 2023Article
- Spatial disparities in impoverishing effects of out-of-pocket health payments in Malawi.Global health action · 2022Article
- The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study.Archives of public health = Archives belges de sante publique · 2022Article
- Are cesarean deliveries equitable in India: assessment using benefit incidence analysis.BMC health services research · 2022Article
- Decomposing socio-economic inequalities in antenatal care utilisation in 12 Southern African Development Community countries.SSM - population health · 2022Article
- Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage.BMC health services research · 2022Article
- How equitable is health spending on curative services and institutional delivery in Malawi? Evidence from a quasi-longitudinal benefit incidence analysis.International journal for equity in health · 2022Article
- Decomposing socio-economic inequality in catastrophic out-of-pocket health expenditures in Malawi.PLOS global public health · 2022Article
- Impact of free maternity policies in Kenya: an interrupted time-series analysis.BMJ global health · 2021Article
- Article
- Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi.PloS one · 2021Article
- Developing Malawi's Universal Health Coverage Index.Frontiers in health services · 2021Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P < 0.01) increase in the mean proportion of women who made at least one antenatal care (ANC) visit during pregnancy, a 12% (P < 0.05) increase in average ANC visits and an 11% (P < 0.05) increase in the mean proportion of pregnant women who delivered at the facilities. No effects were found for the proportion of pregnant women who made the first ANC visit in the first trimester and the proportion of women who made postpartum care visits. We conclude that user fee exemption is an important policy for increasing maternal health care utilization. For certain maternal services, however, other determinants may be more important.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.