Estimating the distributional incidence of healthcare spending on maternal health services in Sub-Saharan Africa : benefit incidence analysis in Burkina Faso, Malawi, and Zambia

Improving access to maternal health services is a critical policy concern, especially in Sub- Saharan Africa (SSA) where maternal mortality rates remain very high, particularly so among the poorest segments of society. Hence, following the global call to reduce maternal mortality embedded in the Sustainable Development Goal 3, multiple interventions have been designed and implemented across SSA countries to foster progress towards Universal Health Coverage (UHC) of maternal health services, including skilled birth attendance. While evidence on the impact of these interventions on access to service use is increasing, evidence on the distributional incidence of the financial investment they entail is still limited. This paper aims to close this gap in knowledge by conducting a quasi-longitudinal benefit incidence analysis to assess equality of both public and overall health spending on maternal health services in three Sub-Saharan African countries: Burkina Faso, Malawi and Zambia. The study relied on healthcare utilization data derived from different nationallevel household surveys (including Demographic and Health Survey, Performance based Financing Survey, and Zambia Household Health and Expenditure Survey) and health expenditure data derived from National Health Accounts. The findings demonstrate increasing equality in health spending over time, but also considerable persistent heterogeneity in distributional incidence across provinces/regions/districts. These findings suggest that the implementation of UHC-specific reforms targeting maternal care was effective in increasing equality in health spending, meaning that more financial resources reached the poorest segments of society, but was not yet sufficient to remove differences across provinces/regions/districts. Further research is needed to investigate sources of regional disparities and identify strategies to overcome them.