Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity in Bangladesh: Maternal and Child Health Expenditure in Bangladesh - Technical Report C

Publication | December 2012

The objectives of this study are to estimate the levels of public and private spending on maternal, neonatal, and child health patient care services in Bangladesh and their distribution by types of service.

The burden of poor maternal, neonatal, and child health (MNCH) varies greatly across Asia and the Pacific, and is among the highest in the world in certain countries in the region. One of the most important barriers is the frequent need for households to pay out-of-pocket for treatment. This financial barrier can substantially reduce access to and use of services, as well as increase inequity in health outcomes. In addition, such payments can adversely affect household welfare through their impact on overall household savings and consumption.

This review sought to compile and assess the available global evidence on the mechanisms through which MNCH care expenditures heighten poverty and affect households in developing economies, particularly in Asia and the Pacific. A total of 127 studies were identified and included in the present review.

Findings

MNCH care expenditures indirectly influence household poverty through the coping strategies that households adopt to deal with the expenditures. Households that use their savings and sell off assets to pay for MNCH care erode their asset base and make themselves more vulnerable to other economic shocks. If they borrow at high interest rates from moneylenders and are unable to make interest payments, their indebtedness grows. In several Asian countries, borrowing by families to defray large MNCH costs leads to reduced consumption of essentials such as food and education in order to make repayments. The negative impact of MNCH payments thus often far outlasts the initial costs.

Evidence suggests that households choose to forgo MNCH care to avoid the financial costs. Given the critical lack of informed demand for formal health services in MNCH care, financial barriers such as this will significantly undermine efforts to expand the use of services. These financial costs appear to be major barriers to improving access to and use of MNCH services in many countries in Asia and the Pacific, and contribute significantly to observed inequalities in access and MNCH outcomes.

Contents 

  • Preface
  • Executive Summary
  • Introduction
  • Methods and Results
  • Discussion
  • References