Fee exemption for caesarean section in Morocco

Financial barriers are an important obstacle for access to emergency obstetric care and a contributing factor to too slow a reduction in the level of maternal mortality. In Morocco, in 2009, a fee exemption policy for delivery and caesarean section was implemented in public maternity hospitals. As in most countries where a fee exemption policy has been implemented, fee exemption is considered synonym to free care. However, other direct costs may subsist. The objective of this study was to get an estimate of the actual cost of caesarean sections from the patients' perspective. 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 US169 (95% Confidence Interval (CI): 153, 185) at the provincial and regional hospitals, and US291 (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.