Evaluating the economic outcomes of the policy of fee exemption for maternal delivery care in Ghana

Abstract

SUMMARYBackground: The Government of Ghana's fee exemption policy for delivery care introduced in September 2003, aimed at reducing financial barriers to using maternal services. This policy also aimed to increase the rate of skilled attendance at delivery, reduce maternal and perinatal mortality rates and contribute to reducing poverty. Objective: To evaluate the economic outcomes of the policy on households in Ghana. Methods: Central and Volta regions were selected for the study. In each region, six districts were selected. A two stage sampling approach was used to identify women for a household cost survey. A sample of 1500 women in Volta region (made up of 750 women each before and after the exemption policy) and 750 women after the policy was introduced in Central region. Outcome Measures: Household out-of-pocket payment for maternal delivery and catastrophic out-of-pocket health payments. Results: There was a statistically significant decrease in the mean out-of-pocket payments for caesarean section (CS) and normal delivery at health facilities after the introduction of the policy. The percentage decrease was highest for CS at 28.40% followed by normal delivery at 25.80%. The incidence of catastrophic out-of-pocket payments also fell. At lower thresholds, the incidence of catastrophic delivery payment was concentrated more amongst the poor. For the poorest group (1

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

“…25,26 Although user fee exemptions have been one of the key strategies to increase access to delivery care in subSaharan Africa, 27 their impact on caesarean delivery rates has yet to be rigorously evaluated. While such fee exemptions may have contributed to the rises seen in caesarean delivery rates in countries such as Ghana and Senegal, 28,29 such rises cannot be categorically attributed to the exemptions. Furthermore, a household's N e p a l N ig e r N ig e r ia P a k is t a n R w a n d a S e n e g a l Z a m b ia Z im b a b w e U g a n d a U n it e d R e p u b li c o f T a n z a n ia C h a d …”

Community-Based Maternal and Neonatal Health Services in Kolda and Sedhiou Districts of Senegal

“…In most countries where these policies have been put in place, they have promoted access to care for the poor (Ensor & Ronoh, 2005), thereby reducing social inequalities in health (Nabyonga, Desmet, & Karamagi, 2005). However, some writings show that they do not always benefit the poorest (Asante et al, 2007). In some contexts, they would have even benefited the non-poor more than the poor (Leighton & Diop, 1995).…”

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