The Bangladesh Maternal Health Voucher Scheme: impact on completeness of antenatal care provision

This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview findings from a survey of 2,400 randomly selected women aged 15-49 with children 0-23 months in four geographical areas where voucher scheme implementation was under way. Of these, 1,944 had attended at least one antenatal clinic visit so were included in this analysis. A ‘completeness index’ for antenatal visits was constructed as an outcome variable based on recall of 13 elements of care. Bivariate analysis against independent variables of interest was carried-out and developed multivariate linear regression models to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher ‘completeness index’ scores with a mean score of 185.2±101.0 for members and 139.6±93.3 for non-members (P<0.001). Scheme membership reduced differentials associated with health facility type and socioeconomic status. Women from the lowest socioeconomic group who were voucher scheme members received substantially more components of antenatal care (mean score: 159.6±82.1) compared to non-members (mean score: 115.7±83.0). This favourable effect of voucher scheme membership on the most vulnerable socioeconomic group remained significant after adjusting for educational status. The Bangladesh voucher scheme model has the potential to maximize gains in maternal and newborn health through enhancing the completeness of service provision. Studies with sufficient power to assess maternal and newborn morbidity and mortality outcomes are required, as is a focus on women’s experience of care as well as coverage.