Determinants of use of supervised delivery care under Ghana’s fee exemption policy for maternal healthcare: the case of the Central Region

Abstract

BackgroundImproving access to supervised and emergency obstetric care resources through fee reduction/exemption maternity care initiatives has been touted as one major strategy to avoiding preventable maternal deaths. Evaluations on the effect of Ghana’s fee exemption policy for maternal healthcare have largely focused on how it has influenced health outcomes and patterns of use of supervised care with little attention to understanding the main factors influencing use. This study therefore sought to explore the main individual and health system factors influencing use of delivery care services under the policy initiative in the Central Region.MethodsA cross-sectional study was conducted using 412 mothers with children aged less than one year in one largely rural and another largely urban districts in the Central Region of Ghana from September to December 2013. Data were collected using a questionnaire survey on the socio-demographic characteristics of mothers, their knowledge and use of care under the fee free policy. Chi-square and Binary Logistic Regression tests were used to evaluate the main determinants of delivery care use under the policy.ResultsOut of the 412 mothers interviewed, 268 (65 %) reported having delivered their most recent birth under the fee exemption policy even though awareness about the policy was almost universal 401 (97.3 %) among respondents. Utilization however differed for the two study districts. Respondents in the Cape Coast Metropolis (largely urban) used delivery service more (75.7 %) than those in the largely rural Assin North Municipal area (54.4 %).Binary logistic regression results identified maternal age, parity, religion, place of residence, awareness and knowledge about the fee exemption policy for maternal healthcare as significantly associated with the likelihood of delivery care use under the policy. The likelihood of using supervised delivery care under the policy was lower for mothers aged 20–29 compared to those in the age bracket of 40–49 (Odds ratio (OR) = 0.069, p = 0.003). For their index (last child), mothers who already had 1, 2 or 3 births were more likely to deliver under the policy than those with five or more births.Mothers living in urban areas were 3.79 times more likely to use delivery services under the policy than those living in rural areas (OR = 3.793, p = 0.000). The likelihood of using delivery services under the policy was higher for mothers who were aware and had full knowledge of the total benefit package of the policy (OR = 13.820, p = 0.022 and OR = 2.985, p = 0.001 for awareness and full knowledge respectively).ConclusionsDelivery service use under the free maternal healthcare policy is relatively low (65 %) when compared with nearly universal awareness (97.3 %) about the policy. Factors influencing delivery service use under the policy operate at both individual and policy implementation levels. Effective interventions to improve delivery service use under the policy should target the underlying individual and health policy implementation fact...

Impact of a bottom-up community engagement intervention on maternal and child health services utilization in Ghana: a cluster randomised trial

“…Findings of this study nonetheless, validate some literature on Ghana [20] and other African countries [21, 22] where client-centered healthcare system is advocated through bottom-up community engagement to promote acceptability and utilization of safer healthcare services. Previous studies have blamed the lack of clients’ confidence in formal healthcare systems on low level of engagement of communities in the entire value chain of healthcare delivery [18, 20].…”

“…Engagement of clients in health service delivery is more likely to enhance knowledge levels of mothers on importance of antenatal and postnatal care services as alluded by Asante-Sarpong et al [20]. Similarly, a study by Agbozo et al [16] underscored the positive association between a community-based health programme on child welfare, growth monitoring and mothers’ satisfaction level with service quality in a study on Ghana.…”

Assessing the Uptake of Supervised Delivery in the Akuapem South District in the Eastern Region of Ghana

“…"Nearly nine in ten women in urban areas (88%) deliver in a health facility, compared to 53 percent of their rural counterparts" (MICS, 2011) [8]. These findings are confirmed by the findings of Asante-Sarpong et al, (2016) which revealed; "Mothers living in urban areas are 3.79 times more likely to use skilled delivery services under the NHIS policy than those living in rural areas" [9].…”

“…Research findings by Asante-Sarpong et al, (2016) revealed that delivery service use under the free maternal healthcare policy is relatively low (65%) when compared with nearly universal awareness (97.3%) of Ghanaian pregnant women about the policy. However, "the likelihood of using delivery services under the policy is higher for mothers who are aware and has full knowledge of the total benefit package of the policy" [9].…”

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“…It is estimated that 99% of all maternal-related deaths occur in low- and middle-income countries, of which most (66%) are located in sub-Saharan Africa (SSA) [5–8]. Maternal mortality in SSA is 1 in 39 live births, whereas it is 1 in 3800 live births in high-income countries [9, 10], 1 in every 130 live births in Oceania, and 1 in every 160 live births Southern Asia [5–8]. Therefore, increasing access to quality maternal healthcare services in SSA has been a global priority since the inception of the Millennium Development Goals to date.…”