Impact of Free Delivery Care on Health Facility Delivery and Insurance Coverage in Ghana’s Brong Ahafo Region

Abstract

BackgroundMany sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care – the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana’s policies.MethodsWe used time-series methods to assess the impact of Ghana’s 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality.ResultsFacility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes.ConclusionProviding free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.

Sustaining the National Health Insurance Scheme in Ghana: Perceptions and Experiences of Health Care Providers and Subscribers

“…The basis for the above ratings included; attitude of staff, waiting time, availability of medicines at the facilities, physical examination by clinicians. This finding is in line with those of (Dzakpasu et al, 2012;MoH, 2007;Fusheini et al, 2012) who identified that patient satisfaction with the quality of health care in NHIS-accredited health facilities remains low especially with regard to staff attitudes and long waiting times, differential treatment for NHIS-insured and non-NHIS insured clients, quality of drugs covered by the NHIS, and limited client/community engagement in NHIS activities. It is of the view of the authors that this practice could erode confidence in the operation of the scheme thereby affecting (re) enrolment and hence demand for health service.…”

The Roles of Infrastructure and Resources on Implementation of Free Maternal Healthcare Services in Machakos Level 5 Hospital, Machakos County, Kenya

“…Hospitals have reported increased overcrowding at maternity wards for instance Kenyatta National Hospital in May 2013 reported 938 deliveries as compared to 1375 in May 2014 this increase was occasioned by introduction of free maternity services in all public hospitals in Kenya. These findings compare with findings on a study on exemption policy in Ghana which confirmed that introduction of free delivery care policy is associated with an increase in facility deliveries [14].…”

Institutional Delivery Service Utilization and Associated Factors among Women of Child Bearing Age at Boset Woreda, Oromia Regional State, Central Ethiopia

“…Maternal health is part of the family health package and includes delivery of normal births [18,19]. There is evidence from a number of countries that materialization of those initiatives improved utilization of target services and had a positive impact on the rate of assisted deliveries and/or Cesarean sections [20][21][22].…”