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

Njoumemi Zakariaou; Abdoulnassir Amadou; Fadimatou Altine; Hafsatou Younous Diddi; Dingom Ange Madye; Mossus Tatiana; Essi Marie-José

doi:doi:10.11648/j.wjph.20251003.18

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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

Njoumemi Zakariaou

, Abdoulnassir Amadou^*

, Fadimatou Altine

, Hafsatou Younous Diddi

, Dingom Ange Madye

, Mossus Tatiana

, Essi Marie-José

Published in World Journal of Public Health (Volume 10, Issue 3)

Received: 17 June 2025 Accepted: 30 June 2025 Published: 28 July 2025

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Abstract

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.

Published in	World Journal of Public Health (Volume 10, Issue 3)
DOI	10.11648/j.wjph.20251003.18
Page(s)	273-281
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Antenatal Care Quality, Registration Time, Voucher Scheme Financing, Adamawa-Cameroon

References

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[2]	Carvajal–Aguirre L, Amouzou A, Mehra V, Ziqi M, Zaka N, Newby H. Gap between contact and content in maternal and newborn care: An analysis of data from 20 countries in sub–Saharan Africa. J Glob Health. 2017; 7(2): 1‑8.
[3]	National Institute of Statistics (Cameroon) and ICF. 2018 Cameroon Demographic health and surveys. Yaounde/Rockville - Maryland: INS et ICF; 2018. Available from: https://dhsprogram.com/pubs/pdf/FR360/FR360.pdf (accessed 15/12/2023).
[4]	World Health organization. Tracking 100 core health indicators in Cameroon in 2019 & SDG Focus. Yaounde Cataloguing-in-publication (CIP) data. Available at: https://www.minsante.cm/site/sites/default/files/Tracking%20100%20Core%20HealthIndicators%20%20in%20Cameoon%20in%202019%20%26%20SDG%20%20Focus-En.pdf (accessed 15/12/2023).
[5]	Arsenault C, Jordan K, Lee D, Dinsa G, Manzi F, Marchant T, et al. Equity in antenatal care quality: an analysis of 91 national household surveys. The Lancet Global Health. nov 2018; 6(11): e1186‑95.
[6]	Uwimana G, Elhoumed M, Gebremedhin MA, Nan L, Zeng L. Determinants of timing, adequacy and quality of antenatal care in Rwanda: a cross-sectional study using demographic and health surveys data. BMC Health Serv Res. 6 mars 2023; 23(1): 217.
[7]	Cameroon Ministry of public health. Updated health voucher operational programming document. Yaounde; MINSANTE; 2020.
[8]	Bobo FT, Asante A, Woldie M, Hayen A. Poor coverage and quality for poor women: Inequalities in quality antenatal care in nine East African countries. Health Policy and Planning. 3 juin 2021; 36(5): 662‑72.
[9]	Jordanwood, Tapley, Nakyanzi A, Tumukurate E, Tabusibwa E, Mwaka J, et al. Reproductive Health Voucher Schemes in Uganda: How They Worked and Key Lessons for the Future. 2021.
[10]	World Bank. PIB ($ US courants) - Cameroon, Uganda [Internet]. World Bank Open Data. [accessed 26 mai 2024]. Available at: https://data.worldbank.org
[11]	Ahmed S, Khan MM. A maternal health voucher scheme: what have we learned from the demand-side financing scheme in Bangladesh? Health Policy and Planning. 1 janv 2011; 26(1): 25‑32.

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APA Style

Zakariaou, N., Amadou, A., Altine, F., Diddi, H. Y., Madye, D. A., et al. (2025). 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. World Journal of Public Health, 10(3), 273-281. https://doi.org/10.11648/j.wjph.20251003.18

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ACS Style

Zakariaou, N.; Amadou, A.; Altine, F.; Diddi, H. Y.; Madye, D. A., et al. 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. World J. Public Health 2025, 10(3), 273-281. doi: 10.11648/j.wjph.20251003.18

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AMA Style

Zakariaou N, Amadou A, Altine F, Diddi HY, Madye DA, et al. 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. World J Public Health. 2025;10(3):273-281. doi: 10.11648/j.wjph.20251003.18

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@article{10.11648/j.wjph.20251003.18,
  author = {Njoumemi Zakariaou and Abdoulnassir Amadou and Fadimatou Altine and Hafsatou Younous Diddi and Dingom Ange Madye and Mossus Tatiana and Essi Marie-José},
  title = {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
},
  journal = {World Journal of Public Health},
  volume = {10},
  number = {3},
  pages = {273-281},
  doi = {10.11648/j.wjph.20251003.18},
  url = {https://doi.org/10.11648/j.wjph.20251003.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20251003.18},
  abstract = {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 (pConclusion: 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.},
 year = {2025}
}

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TY  - JOUR
T1  - 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

AU  - Njoumemi Zakariaou
AU  - Abdoulnassir Amadou
AU  - Fadimatou Altine
AU  - Hafsatou Younous Diddi
AU  - Dingom Ange Madye
AU  - Mossus Tatiana
AU  - Essi Marie-José
Y1  - 2025/07/28
PY  - 2025
N1  - https://doi.org/10.11648/j.wjph.20251003.18
DO  - 10.11648/j.wjph.20251003.18
T2  - World Journal of Public Health
JF  - World Journal of Public Health
JO  - World Journal of Public Health
SP  - 273
EP  - 281
PB  - Science Publishing Group
SN  - 2637-6059
UR  - https://doi.org/10.11648/j.wjph.20251003.18
AB  - 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 (pConclusion: 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.
VL  - 10
IS  - 3
ER  -

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Author Information

Njoumemi Zakariaou

Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. Health Economics & Policy Research and Evaluation for Development Results Group (HEREG), Yaounde, Cameroon

Contact Email

http://orcid.org/0000-0003-1392-3763
Abdoulnassir Amadou

Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon

Contact Email

http://orcid.org/0009-0003-1134-3260
Fadimatou Altine

Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon

Contact Email

http://orcid.org/0000-0003-3588-6967
Hafsatou Younous Diddi

Regional Funds of Health Promotion, Adamawa Region, Ngaoundere, Cameroon

Contact Email

http://orcid.org/0009-0004-6397-271X
Dingom Ange Madye

Department of Obstetric Gynecology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon

Contact Email

http://orcid.org/0000-0003-0591-4883
Mossus Tatiana

Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon

Contact Email

http://orcid.org/0000-0002-0574-4514
Essi Marie-José

Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon

Contact Email

http://orcid.org/0000-0002-2587-8309

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Plain Text BibTeX RIS

APA Style

Zakariaou, N., Amadou, A., Altine, F., Diddi, H. Y., Madye, D. A., et al. (2025). 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. World Journal of Public Health, 10(3), 273-281. https://doi.org/10.11648/j.wjph.20251003.18

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ACS Style

Zakariaou, N.; Amadou, A.; Altine, F.; Diddi, H. Y.; Madye, D. A., et al. 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. World J. Public Health 2025, 10(3), 273-281. doi: 10.11648/j.wjph.20251003.18

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AMA Style

Zakariaou N, Amadou A, Altine F, Diddi HY, Madye DA, et al. 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. World J Public Health. 2025;10(3):273-281. doi: 10.11648/j.wjph.20251003.18

Copy | Download

@article{10.11648/j.wjph.20251003.18,
  author = {Njoumemi Zakariaou and Abdoulnassir Amadou and Fadimatou Altine and Hafsatou Younous Diddi and Dingom Ange Madye and Mossus Tatiana and Essi Marie-José},
  title = {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
},
  journal = {World Journal of Public Health},
  volume = {10},
  number = {3},
  pages = {273-281},
  doi = {10.11648/j.wjph.20251003.18},
  url = {https://doi.org/10.11648/j.wjph.20251003.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20251003.18},
  abstract = {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 (pConclusion: 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.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - 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

AU  - Njoumemi Zakariaou
AU  - Abdoulnassir Amadou
AU  - Fadimatou Altine
AU  - Hafsatou Younous Diddi
AU  - Dingom Ange Madye
AU  - Mossus Tatiana
AU  - Essi Marie-José
Y1  - 2025/07/28
PY  - 2025
N1  - https://doi.org/10.11648/j.wjph.20251003.18
DO  - 10.11648/j.wjph.20251003.18
T2  - World Journal of Public Health
JF  - World Journal of Public Health
JO  - World Journal of Public Health
SP  - 273
EP  - 281
PB  - Science Publishing Group
SN  - 2637-6059
UR  - https://doi.org/10.11648/j.wjph.20251003.18
AB  - 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 (pConclusion: 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.
VL  - 10
IS  - 3
ER  -

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