Effect of delivery care user fee exemption policy on institutional maternal deaths in the central and volta regions of Ghana

Abstract

Background: To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees. Objective: To examine the effect of the exemption policy on delivery-related maternal mortality. Methods: Maternal deaths in 9 and 12 hospitals in the Central Region (CR) and the Volta Region (VR) respectively were analysed. The study covered a period of 11 and 12 months before and after the introduction of the policy between 2004 and 2006. Maternal deaths were identified by screening registers and clinical notes of all deaths in women aged 15-49 years in all units of the hospitals. These deaths were further screened for those related to delivery. The total births in the study period were also obtained in order to calculate maternal mortality ratios (MMR). Results: A total of 1220 (78.8%) clinical notes of 1549 registered female deaths were retrieved. A total of 334 (21.6%) maternal deaths were identified. The delivery-related MMR decreased from 445 to 381 per 100,000 total births in the CR and from 648 to 391 per 100,000 total births in the VR following the implementation of the policy. The changes in the 2 regions were not statistically significant (p=0.458) and (p=0.052) respectively. No significant changes in mean age of delivery-related deaths, duration of admission and causes of deaths before and after the policy in both regions. Conclusion: The delivery-related institutional maternal mortality did not appear to have been significantly affected after about one year of implementation of the policy.

What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries

“…12,13 A new method for identifying maternal deaths in institutions was developed, called the Rapid Ascertainment Process for Institutional Deaths.…”

A quantitative study on the determinants of utilization of skilled birth attendance, Bamba division, Kilifi

“…5 In spite of undoubted progress towards greater coverage rates, however, studies done in African countries have shown that women continue not to attend ANC services and not to seek skilled attendance at birth even after the exception of user fees. 9,10 This has been attributed to long distances to the health facilities, unavailability of drugs, limited health care workers and cultural practices. [10][11][12][13] It is therefore important to understand who continues to remain excluded from access to maternal care services and determine factors that are associated with the utilization of skilled attendance at birth.…”

Frontline health worker motivation in the provision of maternal and neonatal health care in Ghana

“…Consequently maternal and child health care are key priorities worldwide, which have been clearly enshrined in the Millennium Development Goals 4 (reduce child mortality by two thirds) and 5 (improve maternal health by three quarters) and also in the achievement of the sustainable development goals (Republic of Ghana 2012). To achieve the set targets of Millennium Development Goals (MDG) 4 and 5, the Ghanaian state and other collaborators initiated various intervention policies Bosu et al 2007;Koduah et al 2015;Witter et al 2007). The implementation of policies such as a fee exemption policy for pregnant women and children 1 and the introduction of a national health insurance scheme (NHIS) 2 contributed to only a gradual improvement in the quality of maternal and child health care Bosu et al 2007;Witter et al 2007).…”

“…To achieve the set targets of Millennium Development Goals (MDG) 4 and 5, the Ghanaian state and other collaborators initiated various intervention policies Bosu et al 2007;Koduah et al 2015;Witter et al 2007). The implementation of policies such as a fee exemption policy for pregnant women and children 1 and the introduction of a national health insurance scheme (NHIS) 2 contributed to only a gradual improvement in the quality of maternal and child health care Bosu et al 2007;Witter et al 2007). third from 121.7 to 76.6 per 1000 live births over the same period.…”

“…Various studies have tried to explore the reasons for the slow progress in maternal and child health care (Agyepong and Nagai 2011;Ansong-Tornui et al 2007;Bosu et al 2007; Koduah et al 2015). A recent study by Koduah et al (2015), suggests that the fee exemption policy was not accompanied by an increase in budgetary allocation to the health sector.…”