Bypassing primary healthcare facilities for maternal healthcare in North West Ghana: socio-economic correlates and financial implications

Abstract

Background Bypassing primary health care (PHC) facilities for maternal health care is an increasing phenomenon. In Ghana, however, there is a dearth of systematic evidence on bypassing PHC facilities for maternal healthcare. This study investigated the prevalence of bypassing PHC facilities for maternal healthcare, and the socio-economic factors and financial costs associated with bypassing PHC facilities within two municipalities in Northwestern Ghana. Methods A quantitative cross-sectional design was implemented between December 2019 and March 2020. Multistage stratified sampling was used to select 385 mothers receiving postnatal care in health facilities for a survey. Using STATA 12 software, bivariate analysis with chi-square test and binary logistic regression models were run to determine the socio-economic and demographic factors associated with bypassing PHC facilities. The two-sample independent group t-test was used to estimate the mean differences in healthcare costs of those who bypassed their PHC facilities and those who did not. Results The results revealed the prevalence of bypassing PHC facilities as 19.35 % for antenatal care, 33.33 % for delivery, and 38.44 % for postnatal care. The municipality of residence, ethnicity, tertiary education, pregnancy complications, means of transport, nature of the residential location, days after childbirth, age, and income were statistically significantly (p < 0.05) associated with bypassing PHC facilities for various maternal care services. Compared to the non-bypassers, the bypassers incurred a statistically significantly (P < 0.001) higher mean extra financial cost of GH₵112.09 (US$19.73) for delivery, GH₵44.61 (US$7.85) for postnatal care and ₵43.34 (US$7.65) for antenatal care. This average extra expenditure was incurred on transportation, feeding, accommodation, medicine, and other non-receipted expenses. Conclusions The study found evidence of bypassing PHC facilities for maternal healthcare. Addressing this phenomenon of bypassing and its associated cost, will require effective policy reforms aimed at strengthening the service delivery capacities of PHC facilities. We recommend that the Ministry of Health and Ghana Health Service should embark on stakeholder engagement and sensitization campaigns on the financial consequences of bypassing PHC facilities for maternal health care. Future research, outside healthcare facility settings, is also required to understand the specific supply-side factors influencing bypassing of PHC facilities for maternal healthcare within the study area.

Cost saving in primary versus tertiary level of reproductive health services in Sana’a, Yemen, 2013: a comparative cross-sectional study

“…The utilisation of PHLF instead of THLF saves the family 125% of DMC for VD services. This result is consistent with previous studies in Tanzania, 10 12 16 Bangladesh, 5 14 India, 9 17 Ghana, 3 Malawi, 6 Ethiopia, 13 three African countries (Burkina Faso, Kenya and Tanzania), 11 Zambia, 15 Burkina Faso, 22 Vietnam, 23 Pakistan, 24 Afghanistan 25 and the Democratic Republic of the Congo 26 reported that the DMC of VD was higher at a high level or among bypassers compared with low level or non-bypassers. As well as two systematic reviews studies in low-income and middle-income countries.…”

“…Despite the global efforts to improve primary healthcare services, women still tend to bypass the nearby primary reproductive health services (RHS) and it grows frequently in developing countries. 3 4 Previous studies showed that bypassing the primary health level facilities (PHLF) to use the antenatal care (ANC), 3 5–9 vaginal delivery (VD) 3 5–7 9–17 and family planning services 18 at higher levels even if the care available at the nearby PHLF. These studies indicated that the direct medical cost (DMC), direct non-medical cost (DNMC) and indirect costs (INDC) of RHS are different between PHLF and tertiary health level facilities (THLF).…”

“…The women need more accompanying individuals, long distance and absence from their work to get RHS at higher levels, which is reflected on borne more expenses such as transportation, food, lost wages. 3 5 6 8–11 14–18 Therefore, this phenomenon increases the financial burden on families, underuses the nearby PHLF and overloads the higher level facilities. Conversely, reducing the bypassing would reduce the financial burden borne by families associated with travelling further among bypassers.…”

Why do women attend antenatal care but give birth at home? a qualitative study in a rural Ghanaian District

“…The perceived quality of care is an important determinant of health services use. Perceived quality of care increased the number of women giving birth in health facilities, and women even travelled farther than expected to give birth at facilities, where the quality of care is perceived to be good [ 31 ]. The perceived quality of care further speaks to the issue of ‘respectful maternity care (RMC)’—defined as friendly and woman-centred [ 32 ].…”

Defining service catchment areas in low-resource settings

“…Similarly, people in need of a particular service far away from the border might be attracted to a particular service point in a neighbouring unit due to preferred, desirable characteristics. For example, women bypassed the nearest facility in Tanzania, 9 Ghana, 10 Kenya, 11 Mozambique, India and Pakistan. 12 As a result, it is common practice to have childhood immunisation coverage from routine data greater than 100% in administrative units that attract many people from neighbouring administrative units.…”