The Effect of Demand- and Supply-Side Health Financing on Infant, Child, and Maternal Mortality in Low- and Middle-Income Countries

Abstract —Demand- and supply-side health financing programs that improve maternal and child health are being implemented more frequently; however, there is limited evidence estimating their impact on maternal, infant, and child mortality at the macro level. The purpose of the study was to determine the impact of four specific types of demand- and supply-side health financing programs on infant, child, and maternal mortality at the global level and by county income categories. The following four demand- and supply-side health financing programs were chosen for inclusion in the analysis: conditional cash transfer programs, voucher programs, community-based health insurance, and pay-for-performance schemes. A fixed effects model was estimated, using panel data for 147 countries over the period 1995–2010, to measure the impact of these four demand- and supply-side health financing programs on infant, under-five, and maternal mortality. The model was estimated for all countries and for three country income categories: low, lower–middle, and upper–middle income. The implementation of demand- and supply-side health financing programs has increased over time, with 45 out of 147 countries in the data set implementing at least one of these programs by 2010. The results show that there is a significant decline in infant and under-five mortality from community-based health insurance when examined across all countries. There is also an impact from demand- and supply-side health financing when examined across the three country income classifications, with vouchers and pay-for-performance showing a varying impact on reduced infant, under-five, and maternal mortality depending on the country income classification. Health insurance schemes with a broad population reach, such as community-based health insurance, can have a large impact on infant and under-five mortality. Demand- and supply-side health financing programs, such as pay-for-performance and voucher programs, have a varying impact on infant, under-five, and maternal mortality depending on the income level of the country.

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