Cost-effectiveness analysis of a voucher scheme combined with obstetrical quality improvements: quasi experimental results from Uganda†

• DOI: 10.1093/heapol/czt100
• Publication Date: 2013-12-27T01:09:32Z
• Authors: Y Natalia Alfonso; David Bishai; John Bua; Aloysius Mutebi; Crispus Mayora; Elizabeth Ekirapa...
• Keywords: Voucher; Disability-adjusted life year

The maternal mortality ratio (MMR) in Uganda has declined significantly during the last 20 years, but is not on track to reach millennium development goal of reducing MMR by 75% 2015. More evidence cost-effectiveness supply- and demand-side financing programs reduce could inform future strategies. This study analyses a voucher scheme (VS) combined with health system strengthening rural against status quo. VS, implemented 2010, provided vouchers for delivery services at public private facilities (HF), as well round-trip transportation sector workers (bicycles or motorcycles generally). VS was part quasi-experimental non-randomized control trial. Improvements institutional coverage (IDC) rates can be estimated using difference-in-difference impact evaluation method number lives saved modelled evidence-based Lives Saved Tool. Costs were from primary secondary data. Results show that demand births HFs enrolled increased 52.3 percentage points. Out this value, conservative estimates indicate least 9.4 points are new HF users. 9.4% bump IDC implies deaths averted, which equivalent 1356 disability-adjusted-life years (DALYs) averted. Cost-effectiveness analysis comparing quo VS's most effectiveness shows had an incremental per DALY averted US$302 death US$20 756. Although there limitations data measures, favourable persists even under extreme assumptions. Demand-side supply-side increase attended deliveries cost acceptable.