ArticleBMC health services research2019
Impact of the free healthcare initiative on wealth-related inequity in the utilization of maternal & child health services in Sierra Leone.
Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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39 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis.The lancet. HIV · 2025Pooled it
- The effect of Ebola virus disease on maternal health service utilisation and perinatal outcomes in West Africa: a systematic review.Reproductive health · 2022Pooled it
- Disability-related care trajectories in a pluralistic health system: a qualitative study in urban Sierra Leone.BMC public health · 2026Article
- Hand hygiene compliance among healthcare workers at a tertiary maternity hospital in Sierra Leone: a cross-sectional study.Antimicrobial resistance and infection control · 2026Article
- Challenges and enablers in accessing paediatric inguinal hernia surgical care in Sierra Leone: a qualitative exploratory study.BMJ open · 2026Article
- Development of paediatric surgical care in Sierra Leone: a repeated nationwide cross-sectional study from 2012 to 2023.BMJ public health · 2026Article
- Regional trends, spatial patterns and factors associated with health facility delivery among women of reproductive age in Sierra Leone.Reproductive health · 2025Article
- Cultural, socioeconomic, and demographic factors contributing to child mortality: evidence from Sierra Leone demographic and health survey 2019.BMC public health · 2025Article
- Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature.Maternal and child health journal · 2025Article
- Socio-economic and geographical inequalities in infant mortality rates in Sierra Leone, 2008-2019.BMC public health · 2025Article
- Determinants of poor access to health care among women of reproductive age in Sierra Leone: a cross-sectional study.BMC health services research · 2025Article
- Association between antenatal care visits and under-five mortality: An Analysis of the Pakistan demographic and health surveys.PloS one · 2025Article
- Socioeconomic and geographical inequalities in polio immunisation coverage among two-year-olds in Sierra Leone, 2008-2019.BMC infectious diseases · 2024Article
- Socio-economic and geographical inequalities in neonatal mortality rates in Sierra Leone, 2008-2019.BMC pediatrics · 2024Article
- Trends and inequalities in modern contraceptive use among women in Sierra Leone, 2008-2019.Reproductive health · 2024Article
- Trends and inequalities in adequate antenatal care coverage among women in Sierra Leone, 2008-2019.Archives of public health = Archives belges de sante publique · 2024Article
- Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts' maternal death surveillance and response data.BMJ open · 2024Article
- Evolution in key indicators of maternal and child health across the wealth gradient in 41 sub-Saharan African countries, 1986-2019.BMC medicine · 2024Article
- Do disempowered childbearing women give birth at home in Sierra Leone? A secondary analysis of the 2019 Sierra Leone demographic health survey.BMC pregnancy and childbirth · 2023Article
- Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People's Democratic Republic from 2006 to 2017: MICS data analysis.Tropical medicine and health · 2023Article
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6 authors.
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Abstract
backgroundAs a result of financial barriers to the utilization of Maternal and Child Health (MCH) services, the Government of Sierra Leone launched the Free Health Care Initiative (FHCI) in 2010. This study aimed to examine the impact of the FHCI on wealth related inequity in the utilization of three MCH services.
methodsWe analysed data from 2008 to 2013 Sierra Leone Demographic Health Surveys (SLDHS) using 2008 SLDHS as a baseline. Seven thousand three hundred seventy-four and 16,658 women of reproductive age were interviewed in the 2008 and 2013 SLDHS respectively. We employed a binomial logistic regression to evaluate wealth related inequity in the utilization of institutional delivery. Concentration curves and indices were used to measure the inequity in the utilization of antenatal care (ANC) visits and postnatal care (PNC) reviews. Test of significance was performed for the difference in odds and concentration indexes obtained for the 2008 and 2013 SLDHS.
resultsThere was an overall improvement in the utilization of MCH services following the FHCI with a 30% increase in institutional delivery rate, 24% increment in more than four focused ANC visits and 33% increment in complete PNC reviews. Wealth related inequity in institutional delivery has increased but to the advantage of the rich, highly educated, and urban residents. Results of the inequity statistics demonstrate that PNC reviews were more equally distributed in 2008 than ANC visits, and, in 2013, the poorest respondents ranked by wealth index utilized more PNC reviews than their richest counterparts. For ANC visits, the change in concentration index was from 0.008331[95% CI (0.008188, 0.008474)] in 2008 to - 0.002263 [95% CI (- 0.002322, - 0.002204)] in 2013. The change in concentration index for PNC reviews was from - 0.001732 [95% CI (- 0.001746, - 0.001718)] in 2008 to - 0.001771 [95% CI (- 0.001779, - 0.001763)] in 2013. All changes were significant (p value < 0.001).
conclusionThe FHCI appears to be improving access to and utilization of MCH services, narrowing the inequity in ANC visits and PNC reviews, but is insufficient in addressing wealth- related inequity that exists for institutional deliveries. If Sierra Leone is to realize a significant reduction in maternal and child mortality rates, it needs to strengthen the effective implementation of FHCI considering incorporating a sector wide approach (SWAp) or a "Health in all Policy" framework to reach the less educated, rural residents and ensuring culturally sensitive quality services.
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