Inequality in the quality of health services: wealth, content of care, and the price of antenatal consultations in the Democratic Republic of Congo

We use unique data on direct observations of patient-provider interactions linked to detailed patient exit interviews and household surveys to study the relationship between patients' socioeconomic status and the quality of antenatal care in the Democratic Republic of Congo. We find a significant wealth-quality gradient: a 1 standard deviation in household wealth is associated with a 1.6-3.2 percentage point increase in protocol compliance, depending on the data source and the definition of the compliance index. A large part of the overall wealth-quality gradient is driven by generally lower facility quality in poorer areas. However, we also find a statistically significant within-village wealth-quality relationship that is primarily driven by wealthier women seeking care at higher-quality facilities even if they are more distant. Finally, we find some evidence that even within the same facilities, poorer women tend to receive worse care but, on average, also pay less for care of a given quality.