The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana

Abstract

BackgroundTo promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality. Costs were taken from the perspective of women.MethodsQuantitative and qualitative data collection techniques were used in a convergent parallel mixed methods study. The study used structured questionnaire (n = 353) and focus group discussions (FGDs =7) to collect data from women who gave birth in health facilities. Quantitative data from the questionnaire were analysed, using descriptive statistics. Qualitative data from the FGDs were recorded, transcribed and analysed to determine common themes.ResultsThe overall mean OOP payments during childbirth was GH¢33.50 (US$17), constituting 5.6% of the average monthly household income. Over one-third (36%, n = 145) of women incurred OOP payments which exceeded 10% of average monthly household income (potentially catastrophic). Sixty-nine percent (n = 245) of the women perceived that the NHIS did not cover all expenses incurred during childbirth; which was confirmed in the FGDs. Both survey and FGDs demonstrated that women made OOP payments for drugs and other supplies. The FGDs showed women bought disinfectants, soaps, rubber pads and clothing for newborns as well. Seventy-five percent (n = 264) of the women used savings, but 19% had to sell assets to finance the payments; this was supported in the FGDs.ConclusionThe NHIS policy has not eliminated financial barriers associated with childbirth which impacts the welfare of some women. Women continued to make OOP payments, largely as a result of a delay in reimbursement by the NHIS. There is need to re-examine the reimbursement system in order to prevent shortage of funding to health facilities and thus encourage skilled attendance for the reduction of maternal deaths as well as the achievement of universal health coverage.

Contextualizing the Impact of ‘free’ Maternal Healthcare Policy Implementation: An Intrinsic Case Analysis of Maternal Healthcare Utilization and Stillbirth in Ghana

“…Nearly every pregnant woman paid some amount of money for some sort of laboratory tests in the hospital, abdominal scan services outside the hospitals, or for drugs in the region of $10 to $25.00. This is consistent with the ndings of Dalinjong, Wang and Homer who reported an overall mean out of pocket expenditure of GH 17.50 and GH 33.00 among women who accessed ANC service and facility delivery respectively under the FMHCP in northern Ghana (36,37).…”

Cost of malaria treatment and health seeking behaviour of children under-five years in the Upper West Region of Ghana

“…The sample size for this study was calculated by assuming that 50% of the women in the study districts had at least one child aged less than five years and with 95% confidence level [ 10 , 25 ], and design effect of 1.3 [ 26 ] to account for clustering effect in the districts would require a sample size of 500. Adjusting for a refusal rate of 15% yielded a sample size of 575.…”

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

“…In-depth interviews were conducted among providers and insurance managers (n = 28), while focus group discussions were held with the same category of women (n = 10) who participated in the quantitative study. Details of the design, study area, sampling, data collection and analysis are published in [ 7 , 8 ].…”

“…Therefore, we undertook a study to explore the affordability, availability, acceptability and quality of services under the free maternal health policy. Some of the results have been published in [ 7 , 8 ], specifically those relating to affordability. In this manuscript, we present the overall synthesised results in the form of facilitators and barriers to access to services under the free maternal health policy.…”