UNICEF, Ethiopia.
Int J Gynaecol Obstet. 2011 Dec;115(3):310-5. doi: 10.1016/j.ijgo.2011.09.007. Epub 2011 Oct 8.
To examine user fees for maternity services and how they relate to provision, quality, and use of maternity services in Ethiopia.
The national assessment of emergency obstetric and newborn care (EmONC) examined user fees for maternity services in 751 health facilities that provided childbirth services in 2008.
Overall, only about 6.6% of women gave birth in health facilities. Among facilities that provided delivery care, 68% charged a fee in cash or kind for normal delivery. Health centers should be providing maternity services free of charge (the healthcare financing proclamation), yet 65% still charge for some aspect of care, including drugs and supplies. The average cost for normal and cesarean delivery was US $7.70 and US $51.80, respectively. Nineteen percent of these facilities required payment in advance for treatment of an obstetric emergency. The health facilities that charged user fees had, on average, more delivery beds, deliveries (normal and cesarean), direct obstetric complications treated, and a higher ratio of skilled birth attendants per 1000 deliveries than those that did not charge. The case fatality rate was 3.8% and 7.1% in hospitals that did and did not charge user fees, respectively.
Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under discussion.
考察产妇服务的用户付费情况，以及其与埃塞俄比亚产妇服务的提供、质量和利用之间的关系。
2008 年，国家紧急产科和新生儿护理评估（EmONC）检查了 751 家提供分娩服务的卫生机构的产妇服务用户付费情况。
总体而言，只有约 6.6%的妇女在卫生机构分娩。在提供分娩护理的设施中，68%的设施收取现金或实物费用用于顺产。卫生中心应该免费提供产妇服务（医疗保健融资公告），但仍有 65%的中心对某些护理方面收费，包括药品和用品。顺产和剖宫产的平均费用分别为 7.70 美元和 51.80 美元。这些设施中有 19%在治疗产科急症时需要提前付费。收取用户付费的卫生机构平均拥有更多的分娩床位、分娩（顺产和剖宫产）、直接治疗的产科并发症以及每 1000 例分娩中拥有更高比例的熟练助产士。收取和不收取用户付费的医院的产妇死亡率分别为 3.8%和 7.1%。
埃塞俄比亚的产妇保健服务利用率极低，尽管政府发布了一项法令禁止收取产妇服务费用，但仍有 65%的卫生中心对产妇护理的某些方面收费。由于政府不为产妇服务的费用向卫生机构报销，因此，在继续收取用户付费的卫生机构中，这部分损失的收入可能会导致提供更多和更好的服务。在产妇服务覆盖率极低的情况下，用户付费并不是决定利用率的唯一因素。其他自付费用，如交通费用和陪同亲属的食宿费用，也是额外的因素。在讨论用户付费时，重要的是要牢记护理质量。
