COSTS AND FINANCING OF IMPROVEMENTS IN THE QUALITY OF MATERNAL HEALTH-SERVICES THROUGH THE BAMAKO INITIATIVE IN NIGERIA

This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resou rce implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate re source requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was av ailable in terms of fixed and variable resources required for the deli very of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such c onstraints, it was highly unlikely that technically acceptable standar ds of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious p olicy dialogue. Revenue generation from health services was poor and a ppeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely th at user fees will be necessary to supplement scarce government budgets , especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one th at raises fees to patients, will have to be accompanied by immediate a nd visible quality improvements. Without such quality improvements, co st recovery will result in even lower utilization and attempts to gene rate new revenues are unlikely to succeed.