Assessing Maternal Health and Catastrophic Expenditure (Evidence from Logar, Kabul, Wardak, Nangrahar and Kapisa, Afghanistan)

Abstract

Assessing maternal health in conflict zones has always been an area of interest for researchers around the globe. However, evidence from such settings have been scare due to unfavorable security conditions. This study aimed at looking into accessibility & utilization of maternal health care and out of pocket spending in five provinces including, Logar, Kabul, Wardak, Kapisa, and Nangrahar in Afghanistan. By using purposive sampling technique, the study adopted a cross sectional mixed methods research design to derive results using a semi structure questionnaire. Logistic model was used to analyze cost related to maternal health including average monthly expenditure, child medical cost, intervention needed before and after the birth of the child, and catastrophic expenditure. A total of 350 sample size was used for the descriptive and model analysis. The study revealed that out of the total number of households in all five provinces in Afghanistan, 40% suffered from health catastrophe particularly for lower socio-economic status groups and those with higher out of pocket spending. 64% of the respondents in all five provinces didn’t have money on hand while visiting the doctor. Moreover, 38% of the respondents in five provinces had to use their saving, 18.86% of the respondents had to sell their livestock, 28.28% respondents borrowed from friends, land lords or relatives, whereas 13.43% of the respondents had to sell their land to cover the costs associated with utilization of maternal care. Around 33% of the respondents revealed that they never visited a doctor during pregnancy due to issues in accessibility and high cost of transportation and 10 % of the expecting mothers had still births due to unsuccessful delivery outcomes. Apart from the financial constraints, the qualitative component of the research revealed issues related to poor nutrition during pregnancy, lacking access to basic immunization for infants and better health care for infants and children during illness. The study suggests designing health care financing interventions with a focus on community-based health promotion and utilization programs to reduce the burden of out of pocket spending and improving the accessibility to maternal health care. Moreover, upgrading the existing health care facilities in the area will also help in improving the situation in the target area.