Effectiveness of a free maternal healthcare programme under the National Health Insurance Scheme on skilled care: evidence from a cross-sectional study in two districts in Ghana

Abstract

ObjectivesIn her quest to reduce maternal mortality, Ghana introduced a free maternal healthcare programme under the National Health Insurance Scheme. This study aimed to evaluate if women registered with the insurance had a better chance of accessing maternal healthcare services in two districts in Ghana.SettingWe conducted a cross-sectional quantitative study involving household interviews of all women of the reproductive age group (15–49 years) residing in Kintampo North Municipality and Kintampo South District in Ghana from May to July 2015. Logistics regression analysis at 95% CI was used to determine the independent associations between maternal health insurance and use of antenatal care, facility-based delivery and postnatal care services.ParticipantsWomen who had children aged 3–12 months were selected to take part in the study.ResultsWe observed that women with insurance are 39.5 times more likely to have a maximum of six antenatal care visits and 2.6 times more likely to have an average of four antenatal care visits than those without insurance. Additionally, they are 5.3 times more likely to have facility-based delivery than those without insurance. An association was also found between postnatal care use and insurance as women who do not have insurance are 12.0 (1/0.083) times more likely to receive postnatal care than those with insurance.ConclusionsPregnant women who registered with health insurance had at least four antenatal care visits and delivered in a health facility. However majority of them did not go for postnatal care.

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

“…However, the costs associated with seeking maternal healthcare services may discourage pregnant women, particularly the poor, from receiving healthcare services promptly [38]. As such, in 2003, the NHIS was introduced in Ghana and subsequently, in 2008, a free maternal healthcare programme (FMHCP) was set in motion to alleviate the cost burden associated with seeking maternal healthcare [7]. As a result, pregnant women do not pay a premium for fresh registration or renewal of membership and processing fees [7].…”

“…As such, in 2003, the NHIS was introduced in Ghana and subsequently, in 2008, a free maternal healthcare programme (FMHCP) was set in motion to alleviate the cost burden associated with seeking maternal healthcare [7]. As a result, pregnant women do not pay a premium for fresh registration or renewal of membership and processing fees [7].…”

“…In a related study, Twum et al [7] assessed the effectiveness of a free maternal healthcare programme under the NHIS in Ghana. The social justice and access theory undergird the study.…”

“…Yet, access to maternal healthcare services remains a major development challenge around the world and in Africa, the state of affairs is more disquieting [6]. In sub-Saharan Africa in particular, Twum et al [7] posit that financial constraints tend to erect barriers to access healthcare for the less privileged, particularly women. As a result, Kibusi et al [8] pointed out that since health is fundamentally linked to sustainable development.…”

“…The study presented a national picture but fell short of a discussion of access to maternal healthcare services in rural areas. In a related study, Twum et al [7] investigated access to maternal healthcare services under NHIS's free maternal healthcare policy in relatively well-endowed urban towns of Kintampo and Jema. The authors reported that pregnant women who were covered under the free maternal healthcare policy completed the recommended four antenatal care visits and delivered in a health facility but did not go for postnatal care.…”