Hunter BM, et al. - This article is written with the objective to document experiences and implementation factors related to the utilization of demand-side financing (DSF) in maternal and newborn health. Evaluations spanning over 15 years of implementation of DSF programmes uncover a complex picture of experiences that reflect the significance of financial and other social, geographical and health systems factors as barriers to accessing care. Careful design of DSF programmes as part of broader maternal and newborn health initiatives would need to take into account these barriers, the behaviours of staff and the quality of care in health facilities. Research is still needed on the policy context for DSF schemes in order to comprehend how they become sustainable and where they fit or do not fit, with plans to achieve equitable universal health coverage.

Methods

• In this study, they performed a secondary analysis (utilizing an adapted Supporting the Use of Research Evidence framework - SURE) on studies that had previously been identified in a systematic review of proof on DSF interventions in maternal and newborn health.

Results

• Findings from 49 quantitative and 49 qualitative studies were used to draws this article.
• The studies give insights on difficulties with exclusion of migrants, young and multiparous women, with demands for informal fees at facilities, and with challenges maintaining the quality of care under increasing demand.
• Schemes experienced difficulties if communities faced long distances to reach participating facilities and poor access to transport, and where there were inadequate health infrastructure and human resources, shortages of medicines and problems with corruption.
• Studies that documented enhanced care-seeking demonstrated the significance of adequate programme scope (in terms of programme eligibility, size and timing of payments and voucher entitlements) to address the issue of concern, concurrent investments in supply-side capacity to sustain and/or improve quality of care, and awareness generation using community-based workers, leaders and women’s groups.