Cost to households in treating maternal complications in northern Ghana: a cross sectional study

Abstract

BackgroundThe cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. This study estimated the cost of maternal complications to women and their households in the Kassena-Nankana district of northern Ghana.MethodsWe carried out a cross-sectional study between February and April 2014 in the Kassena-Nankana district. Out of a total of 296 women who were referred to the hospital for maternal complications from the health centre level, sixty of them were involved in the study. Socio-demographic data of respondents as well as direct and indirect costs involved in the management of the complications at the hospital were collected from the patient’s perspective. Analysis was performed using STATA 11.ResultsOut of the 60 respondents, 60% (36) of them suffered complications due to prolonged labour, 17% (10) due to severe abdominal pain, 10% (6) due to anaemia/malaria and 7% (4) due to pre-eclampsia. Most of the women who had complications were primiparous and were between 21–25 years old. Transportation cost accounted for the largest cost, representing 32% of total cost of treatment. The median direct medical cost was US$8.68 per treatment, representing 44% of the total cost of treatment. Indirect costs accounted for the largest proportion of total cost (79%). Overall, the median expenditure by households on both direct and indirect costs per complication was US$32.03. Disaggregating costs by type of complication, costs ranged from a median of US$58.33 for pre-eclampsia to US$6.84 for haemorrrhage. The median number of days spent in the hospital was 2 days - five days for pre-eclampsia. About 33% (6) of households spent more than 5% of annual household expenditure and therefore faced catastrophic payments.ConclusionAlthough maternal health services are free in Ghana, women still incur substantial costs when complications occur and face the risk of incurring catastrophic health expenditure.

Next generation maternal health: external shocks and health-system innovations

“…12 Pregnant women, particularly those with obstetric complications that require surgery and hospital admission, experience high health-care costs in countries without strong insurance systems, and will directly benefit from UHC. 1,66–68 Countries that have adopted national health insurance programmes, such as Mexico and Rwanda, have reduced catastrophic health expenditures. 69,70 A study in Ethiopia found that the inclusion of free caesarean sections in an essential health intervention package averted 98 cases of poverty per $100 000 spent.…”

Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana

“…Similarly, some households in India were found to have made significant OOP payments for maternal health services, even though these services were meant to be free [ 24 ]. A previous study in the Kassena-Nankana municipality, Ghana, where this study was undertaken, revealed that cost of transport alone accounted for about 32% of the total expenditure incurred by families for the treatment of maternal complications during childbirth [ 25 ]. Thus, direct OOP payments in whichever form could still be a serious barrier to the use of health services [ 16 – 18 ].…”

Cost-Effectiveness of Clinical Decision Support System in Improving Maternal Health Care in Ghana

“…Maternal morbidity and mortality can endanger the survival and wellbeing of families [ 35 – 38 ]. Households in the study setting spend about 3% of their annual household expenditure on payments for maternal complications and face the risk of incurring catastrophic health expenditure[ 39 ]. Studies in other parts of Africa have reported that one maternal mortality reduces per capita GDP by US$0.36 per year [ 40 ].…”