Fee exemption for caesarean section in Morocco

This study was carried out in April 2010 in the three public hospitals in Fez. We carried out semi-structured interviews among a sample of 100 women who gave birth by caesarian section in the public hospitals in Fez. The results showed that households paid between US$169 (95% Confidence Interval (CI): 153, 185) at the provincial and regional hospitals, and US$291 (95% CI: 224-359) at the university hospital (UH) where the fee exemption was not applied. The direct cost of a caesarean was mainly influenced by the price of the drugs the families bought, the invoice paid at UH, and the transport. Finally, although the fee exemption policy for caesareans has probably reduced the total cost for households who did not have access to a poverty card, it has not led to 'truly' free caesarean deliveries.The reduction of maternal mortality is one of the Millennium Development Goals (MDGs). It received a lot of media attention, largely because the international community realizes that despite the efforts of the past 20 years, this MDG will not be achieved by 2015 [1].Although the causes of maternal deaths and the medical means to avoid them are well-known, the challenge in most developing countries is to find the right strategic balance between incentives of supply and demand [2]. Lack of access to quality care, particularly the lack of financial access, is a constant headache in poor countries where households are sometimes forced to borrow heavily to pay for transportation and obstetric care if they manage to reach the hospital on time [3,4].In Morocco, a study based on the 1995 Demographic and Health Survey and the Service Availability Module data showed the high negative impact of user fees on utilization of maternity care by the poorer households [5]. Later, in 2004, the Population and Health Family Survey (PHFS) reported that lack of money was a major obstacle to access maternity care for 74% of women interviewed [6].The reduction of maternal mortality became a national pr