An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia

Show simple item record Chama‑Chiliba, Chitalu Miriam Koch, Steven F. 2017-01-18T08:46:44Z 2017-01-18T08:46:44Z 2016-12-07
dc.description.abstract BACKGROUND : Improving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth. METHODS : Data from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006. RESULTS : The difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born. CONCLUSION : The removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact. en_ZA
dc.description.department Economics en_ZA
dc.description.sponsorship CMC was funded by the William and Flora Hewlett Foundation/Institute for International Education (IIE) Dissertation Fellowship in Population, Reproductive Health and Economic Development, as well as the University of Pretoria Commonwealth Scholarship. en_ZA
dc.description.uri en_ZA
dc.identifier.citation Chaba-Chiliba, CM & Koch, SF 2016, 'An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia', BMC Research Notes, vol. 9, art. #504, pp. 1-14. en_ZA
dc.identifier.issn 1756-0500
dc.identifier.other 10.1186/s13104-016-2316-8
dc.language.iso en en_ZA
dc.publisher BioMed Central en_ZA
dc.rights © The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. en_ZA
dc.subject Facility-based deliveries en_ZA
dc.subject Difference-in-differences en_ZA
dc.subject Maternal health en_ZA
dc.subject Zambia en_ZA
dc.subject User fee removal en_ZA
dc.subject Rural areas en_ZA
dc.subject Public health facilities en_ZA
dc.subject Childbirth en_ZA
dc.title An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia en_ZA
dc.type Article en_ZA

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