Bangladesh Demand Side Financing (DSF) Pilot Program
Country of Operation
- Bangladesh Ministry of Health and Family Welfare (MOHFW)Government
- World Health OrganizationForeign aid agency or multilateral organization
SummaryThis is a maternal health voucher program developed by the Bangladesh Ministry of Health and Family Welfare (MOHFW) with support from World Health Organization (WHO) to increase utilization of quality maternal healthcare services particularly by poor women.
The program aims to reduce demand-side barriers faced by poor women so that they will be able to access quality maternal health services.
Key program components
The intervention was implemented through a cash subsidy to pregnant women to cover transport to facility for antenatal care, institutional delivery, and postnatal care and to purchase medicines, while reimbursements for service providers were directed at triggering facility improvements. A total of 37 upazilas (health districts) were covered through means-testing and 9 districts universally covered in two phases between the periods of 2006 and 2007. Phase III is currently underway.
Few private and NGO facilities are part of the DSF program, either because facilities are not available or not interested, or because quality of care is considered to be below standard. Economic evaluation of DSF found that greater efforts should be made to involve private sector and NGO facilities in the voucher program, in order to stimulate competition and improve quality. As a result of this initiative, sub-district level health complexes in DSF program areas are seeing a dramatically and significantly higher number of patients for voucher-covered services than similar health complexes in control areas. Since evidence shows that delivery with a skilled birth attendant reduces the risk of maternal death, these results are very promising, especially in the Bangladeshi context where maternal mortality ratios are very high. Reducing maternal deaths also saves newborn lives, and has substantial social and economic benefits to the family and society. While the quality of care may be slightly better in DSF facilities, quality improvements are still very much needed throughout the government health care system. Economic evaluation of DSF indicated that the presence of an EOC-upgraded facility in a sub-district independently increased the likelihood of women having a facility-based birth, even without the DSF program. The average cost per voucher distributed (based upon the direct costs of the DSF program) is estimated to be US$ 41. In addition to program administrative costs, this cost includes incentives to pregnant women as well as to providers and facilities. An estimated 522,000 people have been served by this program. Population Council, with support from the Bill and Melinda Gates Foundation, is conducting a study of the program to determine it's impact.