National health insurance scheme enrolment and antenatal care among women in Ghana: is there any relationship?

Abstract

Abstractobjectives The objective of this study was to examine whether enrolment in the National Health Insurance Scheme (NHIS) affects the likelihood and timing of utilising antenatal care among women in Ghana.methods Data were drawn from the Ghana Demographic and Health Survey, a nationally representative survey collected in 2008. The study used a cross-sectional design to examine the independent effects of NHIS enrolment on two dependent variables (frequency and timing of antenatal visits) among 1610 Ghanaian women. Negative binomial and logit models were fitted given that count and categorical variables were employed as outcome measures, respectively.results Regardless of socio-economic and demographic factors, women enrolled in the NHIS make more antenatal visits compared with those not enrolled; however, there was no statistical association with the timing of the crucial first visit. Women who are educated, living in urban areas and are wealthy were more likely to attend antenatal care than those living in rural areas, uneducated and from poorer households.conclusion The NHIS should be strengthened and resourced as it may act as an important tool for increasing antenatal care attendance among women in Ghana.

Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context

“…Education provides a protective effect across all outcomes and is corroborated by previous studies (e.g., Dixon et al, 2014). We are of the view that to counteract the potential negative effects of the Ebola epidemic on maternal and child health, a sustained effort to educate and empower women and girls on an enduring basis will have an impact on women's utilization of ANCs services.…”

“…Based on the model, individual and contextual determinants of access and utilization of maternal healthcare include: (1) need for services as indicated by being pregnant or birthing experience and perceptions of the capacity of the health care system; (2) predisposing factors such as demographic characteristics (age, region and place of residence) and beliefs including religious beliefs, attitudes towards health services, knowledge of services and values (Andersen, 1995), and (3) enabling factors, including household resources and accessibility to health care in terms of distance and financial ability. Population-based studies of maternal health service utilization in SSA have supported the Andersen model, suggesting an appraised need for services based on predisposing factors and enabling factors (Arthur, 2012;Dixon et al, 2014;Singh et al, 2014). Yet, in the context of the Ebola epidemic, the absence of health care providers offering relevant services, the inability to differentiate between Ebola and other febrile diseases at onset, and the fear of contracting Ebola at a health facility can also prevent pregnant women from seeking reproductive health services (Davtyan et al, 2014;Walker et al, 2015;Men endez et al, 2015).…”

“…We are of the view that to counteract the potential negative effects of the Ebola epidemic on maternal and child health, a sustained effort to educate and empower women and girls on an enduring basis will have an impact on women's utilization of ANCs services. ANC services provide time and space for health education and promotion, with potential health benefits for both mother and child in the future (Dixon et al, 2014). Maternal health promotion services have not been featured on radio in the same way as HIV/AIDS and Ebola in Liberia.…”

Contraceptive Use in Ghana: What about Women Empowerment?

“…Some health facilities in Ghana are operated by religious bodies (35%), and are collectively referred to as Christian Health Association of Ghana (CHAG). Generally, health facilities and personnel in the country are unevenly distributed with urban centres having more hospitals, clinics, doctors, nurses and pharmacists [35].…”

Unmet reproductive health care needs among rural Ghanaian women

“…These views refer to access barriers such as poor roads and poor-facility transport referral systems, which are well known in Ghana (Asenso-Okyere et al, 1998;Buor, 2003;Overbosch et al, 2004;Pell et al, 2013). The inability for women to own household resources have a negative impact on their ability to meet financial constraints for health care access in Ghana (Atinga & Baku, 2013;Dixon, Tenkorang, Luginaah, Kuuire, & Boateng, 2014;. Our findings show maternity policy strategies such as the freefee delivery policy in Ghana has not been able to tackle indirect cost associations for maternity care.…”