article · Open Access Macedonian Journal of Medical Sciences
An evaluation of the Project Hope cost-removal policy in Cross River State, Nigeria, assessed how free maternal healthcare influences health-seeking behaviour across pregnancy, childbirth, and postpartum stages. Using a mixed-methods approach combining survey data and focus group discussions, the study found quantitative indications of rising service use between 2010 and 2013, surpassing the local population growth rate of 2.9 percent, although overlapping confidence intervals point to weak statistical evidence of change. Qualitative findings confirmed that women perceived an increase in facility-based antenatal, delivery, and postpartum care following fee removal. However, substantial differences exist between urban and rural areas, as well as between communities based on distance to facilities. Continued barriers include indirect costs, inadequate information dissemination, shortages of drugs and supplies, workforce deficits, staff attitudes, and geographical access, demonstrating that financial fee removal alone does not ensure universal maternal healthcare uptake.
Maternal mortality reduction depends heavily on women accessing skilled healthcare during pregnancy and childbirth. This research demonstrates that eliminating user fees is helpful but insufficient on its own. Public health authorities and policymakers must also tackle underlying health system bottlenecks, such as drug shortages, geographic barriers, and quality of care, to translate free healthcare policies into consistently higher service uptake across both rural and urban communities.
The abstract does not indicate a commercialisation pathway, as the study focuses on public policy and healthcare programme evaluation rather than technology or commercial product development. Potential beneficiaries of these findings include public health authorities, development agencies, and healthcare administrators seeking to improve the design and operational delivery of state-funded maternal health programmes.
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BACKGROUND: Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM: This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. METHOD: A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. RESULTS: Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. CONCLUSION: Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.
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DOI: 10.3889/oamjms.2017.075
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