The Contribution of a Voucher Scheme to the Antenatal Care Attendance in the Adamawa Region-Cameroon

A voucher-based health financing mechanism (health vouchers) has been implemented in Cameroon since 2015, with the aim of reducing financial inequalities in the use of services. Despite being one of the first beneficiaries in the country, the Adamawa Region (Cameroon) experienced a decline in antenatal care (ANC) attendance, which decreased from 79.5% in 2014 to 70% in 2018. Therefore, the aim of this research was to analyze the contribution of the Health Voucher scheme (HV) to ANC attendance in Adamawa-Cameroon. A quasi-experimental study (with and without voucher) was conducted with participants selected from 10 health facilities in 5 districts of the Adamawa region. A mixed method (quantitative and qualitative) was used. The number of ANCs was less than 4 among 53.4% in the HV group compared to 49.1% in the non-HV group. The gestational age at first ANC was less than 12 weeks in 8.9% and 11.1% of the HV and non-HV groups respectively, with no significant difference between groups. The determinants of low ANC attendance (<4) was the presence of a male health worker at ANC services. While marital status (single), location of health facilities in semi-urban or rural areas and qualification of providers (state nurse or midwife) contributed to improvement. The determinants of late initiation of ANC were the number of living children between 5 and 9, and the location of health facilities in semi-urban or rural areas. The health voucher scheme did not make a positive contribution to ANC attendance, nor to early initiation of ANC in the Adamawa region. The non-financial barriers identified need to be addressed.