Is the National Health Insurance Scheme helping pregnant women in accessing health services? Analysis of the 2014 Ghana demographic and Health survey

Ameyaw, Edward Kwabena; Baatiema, Linus; Seidu, Abdul‐Aziz

doi:10.1186/s12884-021-03651-6

Cited by 12 publications

(17 citation statements)

References 35 publications

(31 reference statements)

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“…The overall findings showed positive results where the beneficiaries had over 50 percent access to key healthcare services at health facilities at the local level in Ghana. This finding concurs with some recent studies on pregnant women' increased access to maternal healthcare services under NHIS in Ghana (Ameyaw et al, 2021;Ekholuenetale and Barrow, 2021).…”

Section: Discussionsupporting

confidence: 92%

“…Thus, the free maternal health policy has a positive effect on NHIS enrolment (Agbanyo, 2020;Okoroh et al, 2020;Umar et al, 2020;Ekholuenetale and Barrow, 2021). Despite this positive aspect of NHIS, other studies identified some challenges including distance travel to accredited health facilities, travel cost and perceived poor quality of healthcare services rendered to NHIS beneficiaries (Kodom et al, 2019;Ameyaw et al, 2021).…”

Section: Literature Review Implementation Of the Nhis And Implementers And Beneficiaries' Perspectives On Qualitymentioning

confidence: 99%

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Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Kipo-Sunyehzi

2021

PAP

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PurposeThis paper aims to examine the factors that affect the quality of healthcare services in the implementation of the National Health Insurance Scheme (NHIS) at the local level in Ghana from the perspectives of health policy implementers and beneficiaries in public-private organisations.Design/methodology/approachThis paper has adopted a mixed research method with both qualitative and quantitative data, with in-depth interviews, document analysis and focus groups discussions. A total of 107 participants took part in the interviews and the questionnaire survey.FindingsThe study found that these factors greatly affect the quality of healthcare services from the implementers’ perspectives — referrals, effectiveness in monitoring, timeliness, efficiency, reimbursement, compliance with standard guidelines of Ghana Health Service (GHS) and accreditation process. For the beneficiaries, three healthcare services factors are important, including medical consultations, diagnostic services and the supply of drugs and medicines. Some other factors are found to be the least prioritized healthcare services, namely the issuance of prescription forms, verification of identification (ID) cards and staff attitude. However, the study found that implementers and beneficiaries exhibited a mixed reaction (perspectives) on accessing some healthcare services. In some healthcare services where the implementers perceived that beneficiaries have more access to such services, the beneficiaries think otherwise, an irony in the perspectives of the two actors.Originality/valueThis paper adds to the extant literature on the perspectives of policy implementers and beneficiaries on factors that affect the quality of healthcare services in general and specifically on the implementation of NHIS in Ghana with the public-private dimension.

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Section: Discussionsupporting

confidence: 92%

Section: Literature Review Implementation Of the Nhis And Implementers And Beneficiaries' Perspectives On Qualitymentioning

confidence: 99%

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Kipo-Sunyehzi

2021

PAP

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“…We found that women with health insurance coverage were less likely to have prolonged length of hospitalization after vagina delivery. This is positive, as access to the national health insurance scheme (NHIS) eliminates some of the financial barriers that prevent pregnant women with low socioeconomic status from accessing healthcare services including antenatal care [26,27]. Ameyaw et al noted that over 78% of pregnant women admitted to the significance of the NHIS to healthcare accessibility in Ghana [26].…”

Section: Discussionmentioning

confidence: 99%

“…This is positive, as access to the national health insurance scheme (NHIS) eliminates some of the financial barriers that prevent pregnant women with low socioeconomic status from accessing healthcare services including antenatal care [26,27]. Ameyaw et al noted that over 78% of pregnant women admitted to the significance of the NHIS to healthcare accessibility in Ghana [26]. Regardless, since the NHIS do not absorb all maternal health service-related cost [27], some women are detained after delivery due to their inability to afford payments [28].…”

Section: Discussionmentioning

confidence: 99%

Predictors of prolonged hospitalization after vaginal birth in Ghana: A comparative study

Essien

Chireh

Melese

et al. 2022

PLOS Glob Public Health

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Early discharge after child delivery although indispensable, but maybe precluded by several factors. The effect of these factors on prolonged length of stay (LOS) after vaginal delivery has been sparsely investigated in Ghana. This limits understanding of potential leading indicators to inform intervention efforts and optimize health care delivery. This study examined factors associated with prolonged LOS after vaginal birth in two time-separated cohorts in Ghana. We analyzed data from Ghana’s demographic and health surveys in 2007 and 2017. Our comparative analysis is based on subsamples in 2007 cohort (n = 2,486) and 2017 cohort (n = 8,065). A generalized estimating equation (GEE) with logistic regression was used to examine predictors of prolonged LOS after vaginal delivery. The cluster effect was accounted for using the exchangeable working correlation. The odds ratios (OR) and 95% confidence interval were reported. We found that 62.4% (1551) of the participants in 2007 had prolonged LOS after vaginal delivery, whereas the prevalence of LOS in the 2017 cohorts was 44.9% (3617). This constitutes a 17.5% decrease over the past decade investigated. Advanced maternal age (AOR = 1.24, 95% Cl 1.01–1.54), place of delivery (AOR = 1.18, 95% Cl 1.02–1.37), child’s size below average (AOR = 1.14; 95% Cl 1.03–1.25), and problems suffered during/after delivery (AOR = 1.60; 95% Cl 1.43–1.80) were significantly associated with prolonged (≥ 24 hours) length of hospitalization after vaginal delivery in 2017. However, among variables that were available in 2007, only those who sought delivery assistance from non-health professionals (AOR = 1.89, 95% CI: 1.00–3.61) were significantly associated with prolonged LOS in the 2007 cohort. Our study provides suggestive evidence of a reduction in prolonged LOS between the two-time points. Despite the reduction observed, more intervention targeting the identified predictors of LOS is urgently needed to further reduce post-vaginal delivery hospital stay. Also, given that LOS is an important indicator of medical services use, an accurate understanding of its prevalence and associated predictors are useful in assessing the efficiency of hospital management practices and the quality of care of patients in Ghana.

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“…Insurance Scheme. NHIS coverage has increased healthcare utilization among older adults [39] and improved access to maternal and child health services, including antenatal care [40,41] despite the challenges with inequalities. Individuals enrolled in the insurance scheme are reported to be significantly more likely to obtain prescriptions, visit clinics, and seek formal healthcare when sick [42].…”

Section: Acceptability Of Health Services Under the National Healthmentioning

confidence: 99%

Access Differentials in Primary Healthcare among Vulnerable Populations in a Health Insurance Setting in Kumasi Metropolis, Ghana: A Cross-Sectional Study

Acquah-Hagan

Boateng

Appiah-Brempong

et al. 2021

Advances in Public Health

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Background. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. There still remain inequalities in the distribution of health services especially among vulnerable groups despite sustained efforts to strengthen the health system. This study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Methods. This study was a descriptive cross-sectional study conducted among multilevel participants of vulnerable groups in Kumasi Metropolis: 710 vulnerable people constituting elderly/aged (n = 359), pregnant women (n = 117), head poters (teenage girls who migrated from the northern Ghana mainly to the capital cities of the Ashanti and Greater Accra region to help in carrying of goods for their livelihood) (n = 86), sex workers (n = 75), and other vulnerable groups (people with disabilities and street participants) (n = 73). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to access the association between vulnerability and access to healthcare. Results. Close to a fifth, 18.5% of the study respondents were unable to access care at any point in time during the last 12 months. Reasons for the inability to access healthcare included limited funding (69.7%), poor attitude of service providers (7.6%), distance to health centers (8.3%), and religious reasons (6.2%). More than 95% of respondents were insured under the NHIS, but acceptability of service provision under the NHIS was low among the vulnerable groups. In the crude models, pregnant women had lower prevalence of access to medications as compared to the elderly (prevalence ratio (PR): 0.88; 95% CI: 0.80–0.98). Head poters and other vulnerable groups were also less likely to view healthcare as affordable as compared to the elderly. The differences in healthcare access observed were attenuated after adjustment for sociodemographic characteristics and healthcare-related factors. Conclusions. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to work to address access differentials in the NHIS and adopt other innovative care strategies that may have broader applicability for all populations.

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Is the National Health Insurance Scheme helping pregnant women in accessing health services? Analysis of the 2014 Ghana demographic and Health survey

Cited by 12 publications

References 35 publications

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Quality healthcare services under National Health Insurance Scheme in Ghana: perspectives from health policy implementers and beneficiaries

Predictors of prolonged hospitalization after vaginal birth in Ghana: A comparative study

Access Differentials in Primary Healthcare among Vulnerable Populations in a Health Insurance Setting in Kumasi Metropolis, Ghana: A Cross-Sectional Study

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