Abstract
This chapter highlights the gaps and challenges towards achieving the Sustainable Development Goal 3, target 3.8 of universal maternal health coverage in sub-Saharan Africa, including financial risk protection and access to safe, quality, and affordable services by 2030. The analysis focuses on priority countries with high maternal mortality rates (i.e., Nigeria, Sierra Leone, Chad, Liberia, the Democratic Republic of Congo, Guinea-Bissau, Côte d’Ivoire, Cameroon, Mali, Niger, and Kenya). Findings show that considerable numbers of poor pregnant women are still not accessing quality maternal health services in the region because of non-existent or weak national financing strategies that do not reduce or eliminate out-of-pocket payments. The need for effective implementation of social (health) protection programmes in these countries is evident, especially health insurance and fee waivers for antenatal care, delivery, and postnatal care. All priority countries should define equity goals with clear targets every 3–5 years and increase the quality and quantity of data monitoring to monitor progress.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
African Population and Health Research Center (APHRC). (2014). Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-Sectional Slums Survey (NCSS) 2012. Nairobi: NCSS.
Anastasi, E., Ekanem, E., Hill, O., Adebayo Oluwakemi, A., Abayomi, O., & Bernasconi, A. (2017). Unmasking Inequalities: Sub-national Maternal and Child Mortality Data from Two Urban Slums in Lagos, Nigeria Tells the Story. PLOS One, 12(5), e0177190.
Azétsop, J., & Ochieng, M. (2015). The Right to Health, Health Systems Development and Public Health Policy Challenges in Chad. Philosophy, Ethics, and Humanities in Medicine, 10(1), 1.
Bove, A. P. B., Robyn, P. J., & Singh, R. J. (2013). Towards Greater Equity: A Special Focus on Health (English). Cameroon Economic Update; Issue No. 6. Washington, DC: World Bank. Retrieved from http://documents.worldbank.org/curated/en/439211468224677542/Towards-greater-equity-a-special-focus-on-health.
Braveman, P., & Gruskin, S. (2003). Defining Equity in Health. Journal of Epidemiology and Community Health, 57(4), 254–258.
Çalışkan, Z., Kılıç, D., Öztürk, S., & Atılgan, E. (2015). Equity in Maternal Health Care Service Utilization: A Systematic Review for Developing Countries. International Journal of Public Health, 60(7), 815–825.
Dijkstra, G., Akanji, B., Hiddink, C., Sangarabalan, S., & Mevius, F. X. (2011). Mutual Interests—Mutual Benefits: Evaluation of the 2005 Debt Relief Agreement between the Paris Club and Nigeria. Main Report. Ecorys Nederland BV and Oxford Policy Management.
Eyitayo, L., Garand, D., Wipf, J., & Witter, S. (2011). Pre-feasibility Study of Social Health Insurance in Liberia. Oxford: Oxford Policy Management for MOHSW, Monrovia.
Free Healthcare Initiative in Niger Makes Health Gains But Many Challenges Remain. Retrieved from https://reliefweb.int/report/niger/free-healthcare-initiative-niger-makes-health-gains-many-challenges-remain.
Hagen-Zanker, J., & Tavakoli, H. (2011). Fiscal Space for Social Protection in Nigeria. ODI Project Briefing No. 61. London: Overseas Development Institute.
Holmes, R., & Akinrimisi, B. (2011). Social Protection in Nigeria: An Overview of Programmes and Their Effectiveness. Policy Briefing No. 59. London: Oversees Development Institute & UNICEF.
Holmes, R., & Morgan, J. (2011). Social Protection in Nigeria: An Overview of Programmes and Their Effectiveness. Retrieved from http://www.dailymail.co.uk/news/article-3491872/Pregnant-woman-left-die-steps-Cameroon-hospital-no-money-pay-treatment-relatives-tried-vain-deliver-twins-alive.html.
ILO, GTZ, & WHO. (2007). Extending Social Protection in Health: Developing Countries’ Experiences, Lessons Learnt and Recommendation. Retrieved from http://www.who.int/management/district/extendingsocialprotection.pdf.
Jehu-Appiah, C., Aryeetey, G., Spaan, E., de Hoop, T., & Agyepong, I. (2011). Equity Aspects of the National Health Insurance Scheme in Ghana: Who Is Enrolling, Who Is Not and Why? Social Science and Medicine, 72(2), 157–165.
Jesse Uneke, C., Ndukwe, C. D., Abel Abeh Ezeoha, A., & Urochukwu, H. (2013). Improvement of Government’s Free Maternal and Child Health Care Programme Using Community-Based Participatory Interventions in Ebonyi State Nigeria. An Evidence-Based Policy Brief. Retrieved from http://www.who.int/evidence/FMCHPPOLICYBRIEFEBONYI.pdf.
KDHS. (2014). Kenya Demographic and Health Survey. Nairobi: Kenya National Bureau of Statistics.
Kumar, A. K. S., Chen, L. C., Choudhury, M., Ganju, S., Mahajan, V., Sinha, A., et al. (2011). Financing Health Care for All: Challenges and Opportunities. The Lancet, 377(9766), 668–679.
Lang’at, E., & Mwanri, L. (2015). Healthcare Service Providers’ and Facility Administrators’ Perspectives of the Free Maternal Healthcare Services Policy in Malindi District, Kenya: A Qualitative Study. Reproductive health, 12(1), 1–11.
Maina, T., & Kirigia, D. (2015). Annual Evaluation of the Abolition of User Fees at Primary Healthcare Facilities in Kenya. Washington, DC: Futures Group, Health Policy Project.
Miroro, O. O. (2016). The Rise of Social Protection in Sub-Saharan Africa. INCLUDE One-Pager. Retrieved from http://includeplatform.net/wp-content/uploads/2016/03/Rise-Social-Protection-Sub-Saharan-Africa.pdf.
Monchuk, V. (2014). Reducing Poverty and Investing in People: The New Role of Safety Nets in Africa. Washington, DC: World Bank.
MSF Report. Retrieved from http://www.msf.org/en/where-we-work/c%C3%B4te-divoire.
Noubiap, J. J. N., Joko, W. Y. A., Obama, J. M. N., & Bigna, J. J. R. (2014). Community-Based Health Insurance Knowledge, Concern, Preferences, and Financial Planning for Health Care Among Informal Sector Workers in a Health District of Douala, Cameroon. Pan African Medical Journal, 16(1), 17.
Odeyemi, I. A. O. (2014). Community-Based Health Insurance Programmes and the National Health Insurance Scheme of Nigeria: Challenges to Uptake and Integration. International Journal for Equity in Health, 13(1), 20.
Ouattara, A. F., Houngbedji, C. A., & Koudou, B. G. (2013). Free Health Care in Public Health Establishments of Côte d’Ivoire: Born dead. Occupational Medicine and Health Affairs, 1(114), 2.
Parmar, D., De Allegri, M., Savadogo, G., & Sauerborn, R. (2013). Do Community-Based Health Insurance Schemes Fulfil the Promise of Equity? A Study from Burkina Faso. Health Policy and Planning, 29(1), 76–84.
Sarpong, N., Loag, W., Fobil, J., Meyer, C. G., Adu-Sarkodie, Y., May, J., et al. (2010). National Health Insurance Coverage and Socio-Economic Status in a Rural District of Ghana. Tropical Medicine and International Health, 15(2), 191–197.
Scheil-Adlung, X. (2014). Response to Health Inequity: The Role of Social Protection in Reducing Poverty and Achieving Equity. Health Promotion International, 29(Suppl. 1), i59–i67.
Sidze E. M., Mutua, M. K., Amendah, D. D., Fenenga, C., Maina, T. M., Mulupi, S. K., et al. (2019). Trends and Equity in Use of Maternal Health Services Before and After the Free Primary and Free Maternity Care Programs in Kenya. PLOS One (2019).
UNICEF. (2018). Monitoring the Situation of Children and Women. Retrieved from https://data.unicef.org/topic/maternal-health/maternal-mortality/.
Universal Health Coverage Partnership. (2015). Towards A New National Health Policy in Niger. Retrieved from http://uhcpartnership.net/towards-a-new-national-health-policy-in-niger/.
USAID. Global Health. Democratic Republic of Congo. Retrieved from https://www.usaid.gov/democratic-republic-congo/global-health
USAID. Mali Health Strategy. Retrieved from https://www.usaid.gov/sites/default/files/documents/1864/USAID-Mali%20Health%20Strategy%202014-2018.pdf
WHO. (2011). Tobacco Tax Administration. Geneva: World Health Organization.
WHO. (2014). Raising Tax on Tobacco: What You Need to Know. Geneva: World Health Organization.
Witter, S. (2016). The Free Health Care Initiative in Sierra Leone: Six Years on, Six Lessons. The LANCET Global Health Blog. Retrieved from http://globalhealth.thelancet.com/2016/05/31/free-health-care-initiative-sierra-leone-six-years-six-lessons.
World Health Organization. (2010). The World Health Report 2010. Health Systems Financing: The Path to Universal Coverage. Geneva: World Health Organization.
World Health Organization. (2014). World Health Statistics 2014. Geneva: World Health Organization.
World Health Organization. (2016). Country Cooperation Strategy at a Glance. Guinea-Bissau. Retrieved from http://apps.who.int/iris/bitstream/10665/250275/1/ccsbrief_gnb_en.pdf.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 The Author(s)
About this chapter
Cite this chapter
Sidze, E.M., Mutua, M.K., Donfouet, H.P. (2020). Towards Achieving Equity in Utilisation of Maternal Health Services in Selected Sub-Saharan African Countries: Progress and Remaining Challenges in Priority Countries. In: Konte, M., Tirivayi, N. (eds) Women and Sustainable Human Development. Gender, Development and Social Change. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-14935-2_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-14935-2_7
Published:
Publisher Name: Palgrave Macmillan, Cham
Print ISBN: 978-3-030-14934-5
Online ISBN: 978-3-030-14935-2
eBook Packages: Political Science and International StudiesPolitical Science and International Studies (R0)