Improving willingness to pay and utilization of maternal neonatal and child health services by empowering women groups participating in voluntary savings and loans schemes in Gombe state Nigeria

Abstract

Gombe State in North Eastern Nigeria is one of the states in the region that records the highest maternal and newborn death rates in the world. Poverty incidence is 72.2% in the state and a great deal of women in the villages don’t have tangible means of livelihood and heavily rely on their husbands. Empowering these women through formation of women groups saving schemes, literacy, maternal health and vocational training, will improve their economic power and enhance their utilization of these vital maternal services. The study was a quasi-experimental one with non-equivalent experimental and comparison groups. Data for this study were collected using quantitative and qualitative methods through household survey and focus group discussions (FDGs) in two purposively selected intervention Local Government Areas (LGAs) of the state at baseline and 6 months after intervention. Iterative bidding technique was employed to determine the women’s willingness to pay. The main outcome variables are willingness to pay (WTP) and utilization of antenatal care (ANC), facility delivery and post-natal care (PNC) of the women. An association between women’s characteristics and their WTP and utilization of maternal health care services was analysed. The findings show statistically significant changes in the income (z=-6.983, p < 0.001) and the willingness to pay for delivery (z=-2.623, p = 0.009) and PNC (z =-2.465, p = 0.014) services. The correlations between WTP and income with all the services were found. Decision of women independently or jointly with husbands on their health care, religion, ability to read and write local languages were factors found to be associated with WTP for maternal services. Utilization of maternal services was found to be associated with age, current pregnancy, decision on health care, and prices for ANC and PNC services. The FGDs revealed that the groups understand empowerment as a combination of economic power, literacy and ability to take decisions independently. Willingness to pay for maternal care is associated with higher income, autonomy in taking decision for health care needs. Empowering women economically and educationally has potential for improving their willingness to pay for maternal health care needs. Government needs to look at the feasibility of aiding the proliferation of women savings groups especially in rural areas, which are the abodes of women without the ability and willingness to access health care services.