Inequality in Quality of Health Services: Wealth, Content of Care, and Price of Antenatal Consultations in DR Congo

Gil Shapira , The World Bank Group
Eeshani Kandpal, World Bank Group
Guenther Fink, Harvard University

Using unique direct observations of patient-provider interactions linked to patient exit interviews and detailed household surveys, this paper assesses the relationship between patient wealth and the quality and price of antenatal care in DRC. Overall, the analysis finds a significant wealth-quality gradient, with a standard deviation increase in wealth being associated with a four–percentage point increase in protocol compliance. Over half of the wealth-quality gradient is driven by lower facility quality in poorer areas. However, the analysis also finds statistically significant within-village and even within-facility wealth-quality relationships. Within villages, wealth-quality gradients are primarily driven by wealthier women seeking care at higher-quality even if more distant facilities. Within the same facilities, poorer women tend to receive worse care, but on average they also pay less for the same quality of care compared with wealthier women.

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 Presented in Session 172. Improving Maternal and Newborn Health in Sub-Saharan Africa: Financing and Quality of Care