The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the rural areas and in some of the regions. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for the rural dwellers.

The study examines the effect of health expenditure on health outcomes in sub-Sahara African (SSA) countries.These countries have made significant efforts in increasing health expenditure over the years, with the aim of improving health outcomes. Despite this, health outcomes have only responded marginally, raising concerns on the significance of health expenditure in improving health outcomes. The data for the study were sourced from the 2014 World Bank's World Development Indicators for a sample of 40 SSA countries. The study was based on the Grossman Human Capital Model on the demand for health and the fixed effect was used in the empirical analysis. The findings indicate that health expenditure has a significant but inelastic effect on health outcomes in SSA, reducing mortality rates and improving life expectancy at birth. Reductions in mortality rates were significantly influenced by public health expenditure, whereas improvements in life expectancy at birth were significantly influenced by private health expenditure. There is, however, a strong complementary relationship between public and private health expenditures in SSA, despite the dominance of the former over the latter. Given the significant but inelastic effect of health expenditure on health outcomes, the study recommends that SSA countries should make efforts to increase health expenditure in order to improve health outcomes. In particular, there should be deliberate efforts to increase public health expenditure with a view to reducing the burden of private health spending on individuals. This perhaps can be achieved through effective health insurance schemes, which will enable people to save against financial crisis that may arise due to ill health, thereby reducing out-of-pocket health expenditure.Ã Eric Arthur (corresponding author),

PurposeThe purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.Design/methodology/approachThe paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.FindingsThe study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.Research limitations/implicationsThe GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.Practical implicationsThe fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.Originality/valueA new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

Sub-Saharan African countries face significant health challenges, with several countries still far from reaching the health-related targets of the Millennium Development Goals (MDGs). The implication of this on economic growth and individual welfare is daunting. An important channel through which population health affects economic performance is labour supply and productivity. The objective of the study was to investigate a macro level relationship between population health status and labour force participation in sub-Saharan Africa. The study used panel data covering 46 countries from 1990 to 2011. A dynamic panel data model was estimated using the generalized method of moments. The results show that population health status (measured by life expectancy at birth) relates positively with labour force participation. The relationship was significant for total and female labour force participation. The findings call for improved population health status following the importance of labour force participation at the macro levels. Improved labour force contributes to the economic performance of a country at the macro level. Effective policy efforts should be directed towards providing facilities that will improve population health hence providing enough healthy time to participate in the labour force.Note: Labour force participation rate is measured as a percentage of population aged 15-64.

This article examines the effect of health insurance ownership among expectant mothers on facility-based delivery, having controlled for a host of socio-economic and demographic characteristics. Home deliveries often endanger the health of women, where complications are often referred to appropriate health facilities only when the condition has already deteriorated. Consequently, this study examines the extent to which expectant mothers’ access to health insurance influence their choice of delivery facilities broadly categorized into public health facilities, private health facilities and home delivery. Methodologically, the multinomial logistic regression is employed in the empirical estimation. Using the 2008 Ghana Demographic and Health Survey, we found at both the bivariate and multivariate level that women with access to health insurance are more likely to deliver in modern health facilities namely public and private allopathic health facilities relative to home delivery. In particular, women with access to health insurance are approximately 18 percentage points more likely to deliver in a public health facility as compared to home delivery. Also, the propensity to deliver in private health facilities relative to home delivery increases by one percentage point for women with health insurance. Thus, for expectant mothers with health insurance, the utilization of public health facilities predominates. Some of the control variables that were found to significantly influence the choice of delivery facilities include age, educational attainment, wealth quintile, area of residence, religion and region of residence. The study makes a case for scaling up access to health insurance among expectant mothers due to its positive effect on the choice of appropriate delivery facilities.