The Experience of Ghana in Implementing a User Fee Exemption Policy to Provide Free Delivery Care

Abstract

In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to an agreed tariff. The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it. A2007 Reproductive Health Matters. All rights reserved.

Removing the User Fees for the Under-Fives' Simple Malaria Treatment in Cameroon: Effect on the Health Services Utilization

“…In Uganda [22], Ghana [23] and South Africa [24], caregivers felt that user fees abolition mainly benefited the poor. In Ghana, the proportion of primary care delivered increased in each socioeconomic quintile, but the largest increases were observed in the two poorest [25].…”

“…Health professionals in Ghana appreciated the abolition of fees [23,30], however, the effects on job satisfaction vary considerably [23,30]. Studies in Uganda mention the demoralization of staff [22,28].…”

Low Uptake of Intermittent Preventive Treatment in Ghana; An Examination of Health System Bottlenecks

“…Although Ghana implemented a free maternal health care policy which removed all forms of official financial barriers in 2003 [17], other financial impediments arising from under-the-table payments and transportation costs continue to hinder utilisation of services [18]. IPT and other ANC interventions are administered in health centres, which are sparsely distributed in the country [18].…”

Horizontal Inequities In The Uptake Of Hospital Delivery And The Role Of Social Determinants In China

“…Therefore care specific demand side finance may be more effective than wide social protection programs. For that targeted demand side finance approaches like delivery vouchers [30,31] , delivery fee exemptions [32], and conditional cash transfers [33] are all possible effective policy alternatives, with the last two approaches probably more effective, as proposed by the diagonal health system strengthening approach [34]. Meanwhile, the results also sheds light that it is the ability to pay rather than Total -0.110 37.70 59.86 100.00 -0.055 0.00 0.00 100.00 [39].…”