The implementation of the free maternal health policy in rural Northern Ghana: synthesised results and lessons learnt

Abstract

ObjectiveA free maternal health policy was implemented under Ghana’s National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications).ResultsReasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.

Access to Maternal Healthcare Services under the National Health Insurance Policy in the Upper West Region, Ghana

“…The test revealed no significant difference in the cost of seeking delivery care for Wa East (Md = 35, n = 45) and that of Wa West (Md = 45, n = 82), z = −0.715, p = 0.475. This finding agrees with Dalinjong et al [10] assertion that pregnant women still purchase certain items for childbirth under the free maternal health policy in rural Northern Ghana. However, some of the respondents admitted that the cost of these items required for delivery sometimes deters them from going to the health facilities for delivery due to the high poverty levels in the study areas.…”

“…The respondents indicated that they purchased items such as drugs, scan, and laboratory test. The results compare with the findings reported by Dalinjong et al [10] that women still paid for drugs, supplies, and laboratory services including ultrasound scans in rural northern Ghana. Access to maternal healthcare services entails the ability of women to obtain prenatal, antenatal, facility-based delivery and postnatal services [5,37].…”

“…The authors discovered that health insurance status of respondent played an important function in the use of maternal healthcare services and women with health insurance coverage had a better opportunity to use antenatal care, deliver at the facility and postnatal care compared with those who are not registered. Similarly, Dalinjong et al [10] assessed the implementation of the free maternal health policy in rural Northern Ghana using the qualitative approach. The study found that women still paid for drugs, supplies, laboratory services including ultrasound scans and transport as well as the purchase of other items for childbirth.…”

Ghana's national health insurance, free maternal healthcare and facility‐based delivery services

“…As expected, both NHIS enrolment and facility delivery increased significantly after the implementation of the FMH policy. This finding corroborates Dalinjong et al (2018). This is possibly due to the fact that registration with the NHIS became a condition for FMH.…”

“…Again, Ghana's NHIS is a requirement for the FMH and studies have examined the implementation and the effectiveness of the FMH (Anafi et al, 2018; Dalinjong, Wang, & Homer, 2018; Twum, Qi, Aurelie, & Xu, 2018) however, it has not been tested if NHIS enrolment has significantly increased after the introduction of the FMH. Finally, following the theory of the status quo bias , it can be argued that the use of 2008 data to assess NHIS enrolment (Mensah, Oppong, & Schmidt, 2010; Wang et al, 2017) and the FMH which were implemented in 2005 and 2008 respectively in Ghana may not tell convincing stories.…”