Examining the distribution of benefits of a free Maternal and Child Health programme in Enugu State, Nigeria: a benefit incidence analysis.

OBJECTIVE To determine the population groups that benefit from a Free Maternal and Child Health (F-MCH) programme in Enugu state, southeast Nigeria, so as to understand the equity effects of the programme. METHOD A community-based survey was conducted in a rural and urban local government areas (LGAs) to aid the benefit incidence analysis (BIA) of the F-MCH. Data was elicited from 584 randomly selected women of childbearing age. Data on their level of utilization of F-MCH services and their out-of-pocket expenditures on various F-MCH services that they utilized were elicited. Benefits of the F-MCH were valued using the unit cost of providing services while the net benefit was calculated by subtracting OOP expenditures made for services from the value of benefits. Costs were calculated in local currency (Naira (₦)) and converted to US Dollars. The net benefits were disaggregated by urban-rural locations and socio-economic status (SES). Concentration indices were computed to provide the level of SES inequity in BIA of F-MCH. RESULTS The total gross benefit incidence was ₦2.681 million ($7,660). The gross benefit that was consumed by the urban dwellers was ₦1.581 million ($4,517.1), whilst the rural dwellers consumed gross benefits worth ₦1.1 million ($3,608.20). However, OOP expenditure for the supposedly F-MCH was ₦6,527,580 (US$18,650.2) in the urban area, whilst it was ₦3, 194, 706 (US$ 9,127.7) amongst rural dwellers. There was negative benefit incidence for the F-MCH because the OOP exceeded the gross benefits at the point of use of services. There was no statistically significant difference in the benefit incidence and OOP expenditure between the urban and rural dwellers and across socio-economic groups. CONCLUSION The distribution of the gross benefits of the F-MCH programme indicates that it may not have achieved the desired aim of enhanced access particularly to the low-income population. Crucially, the high level of OOP erased whatever societal gain the F-MCH was developed to provide. Hence, there is a need to review its implementation and re-strategize to reduce OOP and achieve greater access for improved effectiveness of the programme.