Ensuring financial access to emergency obstetric care: three years of experience with Obstetric Risk Insurance in Nouakchott, Mauritania.
BACKGROUND
The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries.


METHODS
In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity.


RESULTS
95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered.


CONCLUSIONS
This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.
Renaudin
P
P
Nouakchott Safe Motherhood Project, Direction Régionale des Affaires sanitaires et sociales, Nouakchott, Mauritania.
Prual
A
A
Vangeenderhuysen
C
C
Ould Abdelkader
M
M
Ould Mohamed Vall
M
M
Ould El Joud
D
D
D036861:Delivery, Obstetric / Q000191:economics*; D004632:Emergency Medical Services / Q000191:economics*; D005249:Fees and Charges; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D015271:Insurance Pools; D008427:Maternal Health Services / Q000191:economics*; D008429:Maternal Welfare; D008435:Mauritania; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics*; D011247:Pregnancy; D015397:Program Evaluation; D011787:Quality of Health Care / Q000639:trends; D018570:Risk Assessment; D035141:Voluntary Programs