This comment summarizes the key findings of the captioned report. The full report can be accessed here.
As a context it is important to recognize that Pakistan’s slow progress in achieving the Millennium Development Goals 4 and 5 is reflected in its high burden of maternal and child mortality, third highest on the international platform. The role that reproductive health and well being plays in achieving these goals is crucial. The right for everyone women to have access to affordable user-friendly health services that address their reproductive health needs is set in the United Nations Human Rights Declaration of 1948.
Women from lower socio-economic status are amongst the most vulnerable without the safety net of universal health coverage. In lieu of this there are two government-based social systems but still almost 8 in 10 people pay out of pocket for health services in Pakistan. For many this results in catastrophic expenditure further trapping them in the poverty loop. Heartfile’s Healthcare Financing (HHF) innovation has provided a third option for many impoverished people, especially women seeking treatment for reproductive problems and related payment. The aim of this study was to assess how women pay for reproductive treatment and what financial barriers they faced in the process.
A comparative case study approach was utilized to assess the perceptions of women who had received financial support from HHF (Case Study 1) with the perceptions of those women who had not received any financial support from Heartfile (Case Study 2). Qualitative methods were utilized whereby semi-structured interviews were conducted with both case studies (telephone and face-to-face interviews). A purposive sample of fourteen (n=14) women was obtained from the HHF for Case Study 1 and a random sample of seventeen (n=17) women from a reproductive health clinic in Islamabad for Case Study 2. The interviews were recorded, transcribed and coded to provide thematic data.
Most of the women from this study were suffering from the impact of reproductive healthcare cost in the form of physical illness as well as depression or stress. There were three main coping strategies i.e. borrowing money, selling items to pay for treatment and delaying treatment. The majority of study participants were married during their adolescent years and the majority were not using contraceptives.
The main findings from this research suggest that a combination of interventions is required to tackle specific access barriers and affordability of healthcare. The HHF data base is capturing parameters related to some of these factors which can be utilized to develop contextual interventions. Women at the centre of all health policies are the ultimate goal with political support to make reproductive healthcare affordable and accessible. Reproductive well being is a woman’s right.
Assistant Professor Health Services Academy Islamabad and formerly Senior Researcher Heartfile