Posted on 22 July 2019
We study the impact of contracting-out of maternal health care by the government of Malawi to providers from the Christian Health Association of Malawi (CHAM) in the form of Service Level Agreements (SLAs). Under a SLA, a CHAM facility provides agreed maternal and newborn services free-of-charge to patients, and is reimbursed on a fixed price per service. We merge data on health facilities in Malawi with pregnancy histories from the 2010 Malawi Demographic and Health Survey, and exploit the staggered implementation of SLAs across facilities. Using difference-in-differences, we estimate the differential effects on pregnancy-related health care utilisation to mothers residing near and far from facilities with a SLA over time. Our findings show that SLAs reduced home births and increased skilled deliveries at CHAM hospitals. We observe greater provision of prenatal care services at CHAM health centres
but no overall increase in the number of prenatal care visits. We find evidence of a reduction in certain components of prenatal care.
Full Report: CHE Research Paper 167 (PDF , 1,689kb)
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