Veracity of universal health coverage of maternal and neonatal health care among slum dwellers in a metropolitan city of India – Factors aiding access to and cost of availing these services to the poorest household

Abstract

Background: Maternal, newborn and child essential health services are used as tracer indicators for monitoring universal health coverage among countries. This study aims to measure accessibility, factors aiding access, its associated cost of maternal and neonatal health services (M&NHS) among slum dwellers of Chennai. Methodology: Cross sectional study design with cluster sampling using Probability Proportion Sampling. The study participants were mothers with at least one child delivered alive in the preceding one year. Result: Most women availed antenatal and intranatal services (99% had ten antenatal visits, institutional delivery, immunization, 88.5% had two USG) while Postnatal services was low (34%). Women preferred combination of public and private facility for antenatal out-patient (80%), private for postnatal in-patient (66.7%) and public facilities for intranatal (90%) services. Influencing factor for public facility was free services and claiming cash benefit, for private it was perceived good care and physical proximity. Out of pocket expenditure was highest among users of private facility. Households with catastrophic expenditure were 54.2% (95% CI: 50.03%–58.37%). Use of exclusive private facility had highest risk (OR 60.7 and 73.8) of catastrophic expenditure. Conclusion: Although every woman availed M&NHS, proportion of households facing catastrophic health expenditure was high especially among those using private health facilities. This gap in provision of financial risk protection may push households into eternal poverty and fails the effort to achieve Universal Health Coverage for the poorest.

Keywords

• Catastrophic health expenditure
• Costing
• Health service
• Out of pocket expenditure
• Universal health coverage