Despite challenges, reproductive and sexual health services reach many in need

Swapna Majumdar - CNS
Over three million children died before their fifth birthday in 2010 alone in the Asia Pacific region. Thousands of mothers continue to die unnecessarily while giving birth with this region accounting for close to half of the nearly 500,000 maternal deaths recorded annually across the world. Many of these deaths can be prevented if sexual and reproductive health (SRH) services are accessible and affordable. It is here that innovative government health programmes can make a difference.

In Vietnam, where the rural maternal mortality ratio (MMR) is 145 compared to national MMR of 79, a novel voucher scheme has helped to significantly increase access to sexual reproductive health and family planning services at community health centres. A partnership between the government and Mari Stopes International Vietnam (MSIV) in the form of a social franchising scheme called Tinh Chi Em (Sisterhood) is saving lives said Ms Linh Thi Quy Nguyen, MSIV. She was speaking at the 7th Asia pacific Conference on Reproductive and Sexual Health and Rights (7th APCRSHR).

"These vouchers are reaching out to needy rural women who could not afford SRH services. These women are now accessing services including gynaecological care like sexually transmitted infections (STIs) or reproductive tract infections (RTIs), breast and cervical cancer screening, family planning services and abortion care at franchisee clinics free of charge thanks to these vouchers," said Ms Nguyen.

An assessment of the programme implemented in 40 community health centres and 20 private community clinics showed that there was a 400-500 percent increase in the number of new clients. The 24,988 vouchers distributed in two rural provinces not only encouraged greater utilization of services but also led to better quality of services as franchisee clinics competed for voucher clients.

In Bangladesh, the government introduced a similar innovative voucher scheme to reduce its current maternal mortality ratio (MMR) of 194 per 100,000 live births to 143 by 2015. Targetted at promoting institutional deliveries, the voucher can be used only for maternal health services. An assessment of this maternal health voucher scheme implemented by the government at the sub-district level showed that when reproductive health services were subsidised, there were less barriers preventing women from accessing facility-based services for deliveries. Farhana Rahman Noor, who studied the impact of the scheme said at the conference that there was an increase in the number of institutional deliveries going up from 18.5 percent in 2010 (beginning of study period) to 31 percent in 2012 at the end of the three year study.

Even in India, women were more likely to opt for institutional deliveries if their expenses incurred were subsidised. Presenting findings of a recent study of the government's Janani Suraksha Yojana or JSY (Maternal Protection Scheme) in Rajasthan, Dipiti Govil of the India-based International Institute of Population Sciences, said that by incentivizing women on institutional births, many maternal and infant deaths had been averted. "We studied the efficacy of the programme by estimating the number of maternal deaths averted through institutional deliveries. We found that 3309 maternal deaths had been averted due to JSY. Even though there are other challenges of quality of services and attitudes of service providers, JSY has definitely proven to be a cost effective mechanism to save lives," she said.

Swapna Majumdar, Citizen News Service - CNS
January 2014

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