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Insurance to reduce pregnancy and childbirth-related risks

Context

Mauritania is a poor country and ranks 137th out of 177 countries on the Human Development Index (HDI). Maternal and infant mortality rates remain far too high and underscore both health system lags and problems relating to geographic and financial access to healthcare. The under 5 child mortality stands at 125 per 1 000, half concern 0 to 1 year olds.

To remedy this situation the Ministry of Health has defined both a policy to devolve the health system towards the regions and a program to combat maternal mortality, in particular via the introduction of an obstetrical package.

The obstetrical package, introduced in 2002 with support from French Cooperation, is an insurance system based on shared obstetrical risk: pregnant patients that decide to join pay a subscription fee (the equivalent of 17 euros) which covers all future costs relating to their pregnancies (prenatal consultations, ultrasound scans, examinations), childbirth, whether normal or with complications, and post-natal supervision.

Results have been very positive after five years of activities in the capital Nouakchott and two years in 3 pilot regions: there has been a high number of subscriptions (80% in the regions) and the rate of assisted deliveries has risen sharply (+ 48% in 5 years in Nouakchott).

Encouraging results from this system have led the Ministry of Health and its partners to extend the obstetrical package nationwide.

Objectives

The aim of extending the obstetrical package is to reduce maternal and neonatal mortality in Mauritania. It is based on two specific objectives:

to improve access to care and the quality of patient management for pregnant women
to improve the management of neonatal problems.

Project description

The project is in line with the National Health Strategy and will:

extend the obstetrical package nationwide,
strengthen the capacities of the Ministry of Health to coordinate and monitor the national reproductive health strategy
define and implement a specific strategy for the management of newborns.

The implementation strategy for the package has been designed by the Ministry of Health and involves raising the awareness of populations and authorities, training health staff and managers and providing health centers with a start-up fund for drugs and equipment. The Ministry will be in charge of coordinating and monitoring the program. The project also finances technical assistance to support the Ministry of Health.

Measures to combat neonatal mortality will be implemented and will specifically improve the management of neonatal asphyxia.

Place of women and impacts

The experience in Mauritania is beginning to gain international recognition and is helping define new ways of combating maternal and infant mortality.

The poorest women now have access to quality healthcare thanks to the obstetrical package. The extension of the package nationwide will allow women in rural areas to benefit from quality healthcare and to avoid serious complications such as fistula.

Initial results have shown that the system is autonomous and the accounts are balanced. This will help ensure the sustainability of the system.

The extension of the obstetrical package should reach 80% of the population by 2010 and should allow Mauritania to achieve the Millennium Development Goal to reduce maternal mortality.

Dates and amounts

Start-up: 2008
Financing: €1.1M euro grant

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