Effect of the Voucher-based Health Financing Mechanism on Antenatal Care Quality and Registration Time of Beneficiaries in the Adamawa Region (Cameroon): A Quasi-experimental Study

Background: Antenatal care (ANC) is the first basic health care and service for pregnant women. The quality of ANC remains a major challenge in countries with limited resources. This study aimed to analyse the quality of ANC and to situate the beneficiary’s registration time in the voucher scheme in relation to the continuum of maternal and newborn health care in the Adamawa region. Method: An evaluation study (with and without vouchers) was carried out with participants selected from 10 health facilities in 5 health districts. The ANC quality criteria were selected on the basis of the 5 axes recommended by the WHO, from which 12 interventions were selected. The beneficiary’s registration time in the voucher scheme was recorded via the voucher scheme’s deliverables. Descriptive statistics were performed, and the chi2 test or Fisher test was used for the comparison of proportions with a significance level of 5%. Results: The study participants were 700 pregnant women divided into 2 groups. A comparison of the qualitative aspects of ANC between the 2 groups (voucher and non-voucher groups) revealed a statistically significant difference, with 17.7% of the enrolled participants having benefited from quality ANC, unlike the non-enrolled group, where no woman obtained quality ANC (p< 0.001). Approximately 25.1% were enrolled outside ANC, 83% of whom were enrolled when a complication or pathology that could aggravate the pregnancy occurred. Conclusion: The quality of ANC was better in the enrolled group, although it remained low overall. A non-negligible number of beneficiaries were enrolled late, opening the question of vertical equity measures.