Ensuring financial access to emergency obstetric care: three years of experience with Obstetric Risk Insurance in Nouakchott, Mauritania

Int J Gynaecol Obstet. 2007 Nov;99(2):183-90. doi: 10.1016/j.ijgo.2007.07.006. Epub 2007 Sep 27.


Introduction: The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries.

Methods: In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity.

Results: 95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered.

Conclusion: This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery, Obstetric / economics*
  • Emergency Medical Services / economics*
  • Fees and Charges
  • Female
  • Health Services Accessibility / economics*
  • Humans
  • Insurance Pools*
  • Maternal Health Services / economics*
  • Maternal Welfare
  • Mauritania
  • Obstetrics and Gynecology Department, Hospital / economics*
  • Pregnancy
  • Program Evaluation
  • Quality of Health Care / trends
  • Risk Assessment
  • Voluntary Programs