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Impact evaluation of free delivery care on maternal health service utilisation and neonatal health in Nepal

Lamichhane, Prabhat, Sharma, Anurag and Mahal, Ajay 2017, Impact evaluation of free delivery care on maternal health service utilisation and neonatal health in Nepal, Health Policy Plan, vol. 32, no. 10, pp. 1427-1436, doi: 10.1093/heapol/czx124.

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Title Impact evaluation of free delivery care on maternal health service utilisation and neonatal health in Nepal
Author(s) Lamichhane, Prabhat
Sharma, Anurag
Mahal, Ajay
Journal name Health Policy Plan
Volume number 32
Issue number 10
Start page 1427
End page 1436
Total pages 10
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2017-12-01
ISSN 1460-2237
Keyword(s) impact evaluation
free delivery care
maternal and child health
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
Summary Nepal introduced free delivery services for births in public facilities in 2005 in 25 districts with the intervention initially restricted to women with less than two living children and/or women with obstetric complications. After November 2007, eligibility conditions were relaxed to include all women, and the programme was later expanded to cover an additional 50 districts in December 2008. We exploit the phased expansion of the free birth delivery programme to identify its impact on place of delivery, the presence of skilled birth attendants (SBAs) and neonatal mortality using difference-in-difference methods, on data for 4457 live-births reported between 2001 and 2008 from Nepal Demographic and Health Surveys for 2006 and 2011. Programme impacts were estimated for: (1) initial implementation until the relaxation of eligibility criteria to include all women in November 2007 (early phase); and (2) initial implementation until the programme was expanded nationwide in December 2008 (longer phase). Early implementing districts were treatment districts, while late implementing hill districts were control districts. In the early phase, the likelihood of delivery by SBAs was 5.6 percentage points higher (95%CI 0.002, 0.111) and the likelihood of delivery in a public facility was 5.1 percentage points higher (95%CI -0.003, 0.106) in treatment districts compared with control districts. The programme lowered the likelihood of neonatal mortality by 4.0 (-0.072, -0.009) percentage points for women with less than two living children and by 6.9 percentage points (95%CI -0.104, -0.035) for women from lower castes and indigenous groups in treatment districts compared with women in control districts, during the early phase. Programme effects on use of public facilities for births and deliveries attended by SBAs were not sustained over a longer exposure period. The results on neonatal mortality persisted with longer programme exposure, although the effects were smaller in magnitude.
Language eng
DOI 10.1093/heapol/czx124
Field of Research 1605 Policy And Administration
1117 Public Health And Health Services
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Author
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Document type: Journal Article
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