Analysing the expenditure on childbearing: a community-based cross-sectional study in rural areas of Punjab (India)

The magnitude of out-of-pocket expenditure for antenatal care in low and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Owing to the lack of compiled global evidence on out-of-pocket expenditure (OOPE) for antenatal care (ANC), this systematic review and meta-analysis estimated the magnitude of OOPE for ANC in low and middle-income countries (LMICs).

METHODS

An electronic search was conducted using 10 databases and a hand search of the eligible studies' reference lists. Studies on OOPE for ANC in LMICs, published in English without time restriction, were included. The comparability of OOPE values was improved using inflation and exchange rate adjustment to the year 2019. Random-effects meta-analysis was performed to generate pooled estimates.

RESULTS

Among the 9766 articles retrieved, 32 were selected. Only 13/137 (9.5%) countries reported evidence of OOPE during pregnancy in LMICs. The majority of the studies (n = 2779.4%) were from lower-middle-income settings. Ten (31.3%) studies from African region, 21 (65.6%) studies from South-East-Asian region, 1 (3.1%) study from region of Americas and none from the other regions were included. The average OOPE for ANC and single ANC visit ranged from United States Dollar (USD) 2.41 to USD 654.32 in LMICs, the lowest in Tanzania and the highest in India. The pooled OOPEs were USD 63.29 (95% confidence interval [CI] = 51.93-74.65) and USD 12.93 (95%CI = 4.54-21.31) for ANC and single ANC visit in LMICs, respectively.

CONCLUSION

The study revealed that the pooled estimates of OOPE for ANC throughout pregnancy and per visit were high in some countries, with a wide variability observed across countries. There was a lack of evidence on OOPE for ANC from many LMICs, and filling the evidence gap in LMICs is highlighted.

Emergy-Based Evaluation on the Systemic Sustainability of Rural Ecosystem under China Poverty Alleviation and Rural Revitalization: A Case of the Village in North China

A number of new rural management models have emerged to solve the problems of economic backwardness, insufficient resource utilization, and technical shortages in rural areas in the context of poverty alleviation to the rural revitalization strategy in China. However, the influence of new rural management model under all countermeasures for rural sustainable development with a comprehensive perspective is lacking. Therefore, exploring whether the new rural management model meets the requirements of sustainable development is an urgent issue. From the theory of system metabolism and emergy accounting method, this study classified the government funds for poverty alleviation measures as import resources, and analyzed the metabolic structure, efficiency, and the rural development factors of Chehe Village before and after poverty alleviation measures are carried out (the year of 2012 and 2019) to verify whether the new model was sustainable. According to the results of this study, the new management model of Chehe Village declined the rural system sustainability with the emergy sustainability index decreasing from 1.96 in 2012 to 0.32 in 2019. With the development of economy, the system metabolic efficiency of Chehe Village promoted and the metabolic structure became more reasonable manifesting in the decline of emergy use per unit GDP and the increase of emergy exchange rate. Moreover, production and livelihood had been highly valued in Chehe Village. In conclusion, it is feasible to add countermeasures of poverty alleviation and rural revitalization into the village system metabolism. The new management model of Chehe Village needs to change exogenous force into endogenous force to meet the requirements of rural sustainable development.