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Cost of antenatal care for the health sector and for households in Rwanda

Artikel i vetenskaplig tidskrift
Författare R. Hitimana
L. Lindholm
Gunilla Krantz
M. Nzayirambaho
A. M. Pulkki-Brännström
Publicerad i BMC Health Services Research
Volym 18
ISSN 1472-6963
Publiceringsår 2018
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för folkhälsoepidemiologi
Språk en
Ämnesord Antenatal care, Cost of care, Rwanda
Ämneskategorier Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi


Background: Rwanda has made tremendous progress in reduction of maternal mortality in the last twenty years. Antenatal care is believed to have played a role in that progress. In late 2016, the World Health Organization published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other changes. There is ongoing debate regarding the cost implications and potential outcomes countries can expect, if they make that shift. For Rwanda, a necessary starting point is to understand the cost of current antenatal care practice, which, according to our knowledge, has not been documented so far. Methods: Cost information was collected from Kigali City and Northern province of Rwanda through two cross-sectional surveys: a household-based survey among women who had delivered a year before the interview (N = 922) and a health facility survey in three public, two faith-based, and one private health facility. A micro costing approach was used to collect health facility data. Household costs included time and transport. Results are reported in 2015 USD. Results: The societal cost (household + health facility) of antenatal care for the four visits according to current Rwandan guidelines was estimated at $160 in the private health facility and $44 in public and faith-based health facilities. The first visit had the highest cost ($75 in private and $21 in public and faith-based health facilities) compared to the three other visits. Drugs and consumables were the main input category accounting for 54% of the total cost in the private health facility and for 73% in the public and faith-based health facilities. Conclusions: The unit cost of providing antenatal care services is considerably lower in public than in private health facilities. The household cost represents a small proportion of the total, ranging between 3% and 7%; however, it is meaningful for low-income families. There is a need to do profound equity analysis regarding the accessibility and use of antenatal care services, and to consider ways to reduce households' time cost as a possible barrier to the use of antenatal care.

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