Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana

Abstract

BackgroundThere is a growing movement, globally and in the Africa region, to reduce financial barriers to health care generally, but with particular emphasis on high priority services and vulnerable groups.ObjectiveThis article reports on the experience of implementing a national policy to exempt women from paying for delivery care in public, mission and private health facilities in Ghana.DesignUsing data from a complex evaluation which was carried out in 2005–2006, lessons are drawn which can inform other countries starting or planning to implement similar service-based exemption policies.ResultsOn the positive side, the experience of Ghana suggests that delivery exemptions can be effective and cost-effective, and that despite being universal in application, they can benefit the poor. However, certain ‘negative’ lessons are also drawn from the Ghana case study, particularly on the need for adequate funding, and for strong institutional ownership. It is also important to monitor the financial transfers which reach households, to ensure that providers are passing on benefits in full, while being adequately reimbursed themselves for their loss of revenue. Careful consideration should also be given to staff motivation and the role of different providers, as well as quality of care constraints, when designing the exemptions policy. All of this should be supported by a proactive approach to monitoring and evaluation.ConclusionThe recent movement towards making delivery care free to all women is a bold and timely action which is supported by evidence from within and beyond Ghana. However, the potential for this to translate into reduced mortality for mothers and babies fundamentally depends on the effectiveness of its implementation.

Predictors of Patient Satisfaction With Quality of Healthcare in University Hospitals in Ghana

“…Existing empirical evidence indicates that a less noisy environment and modern recreational facilities help patients recover in a timely manner. 12,25 The significant contribution of culture to patient's satisfaction at university hospitals is very interesting. It reflects the idea that patients' satisfaction with healthcare delivery is influenced by language, religion, and ethnic background.…”

“…Studies have confirmed that patients share the view that healthcare service that is culturally sensitive to their healthcare needs ensures satisfaction and promotes quality healthcare delivery. 10,12 Moreover, prioritizing healthcare based on patients' needs is relevant to ensuring healthcare delivery. Previous studies on patient satisfaction have revealed that priority care is fundamental to the assessment of service quality at hospitals.…”

“…8,9 In Ghana, many of the studies on healthcare quality have focused on quality award dimensions. [10][11][12][13] Studies conducted in public hospitals over the years have provided substantive evidence that the quality of healthcare services is inadequate both by objective measures in the opinions of patients and by healthcare providers. 14,15 Moreover, research on quality healthcare has generally reported poor service delivery through long waiting times, frequent shortages of drugs, and the poor attitudes of healthcare providers as factors militating against patient satisfaction with healthcare in Ghana.…”

National level maternal health decisions : towards an understanding of health policy agenda setting and formulation in Ghana

“…For example, generating political will for safe motherhood in Indonesia (Shiffman, 2003), the state of political priority for safe motherhood in Nigeria (Shiffman and Okonofua, 2007), the emergence of political priority for safe motherhood in Honduras (Shiffman et al, 2004), and actors practise of power in a South African community health programme (Lehmann and Gilson, 2013). Most empirical research on maternal health in Ghana and other LMICs (Travis et al, 2004, Borghi et al, 2006, Adam et al, 2005, Gupta et al, 2011, Asamoah et al, 2011, Phillips et al, December 2006, Witter et al, 2009) focused more on implementation challenges such as scarcity of resources, shortage of skilled health personal, inadequate quality of care, and recommendations of potential policies that should improve maternal health, and less on how the implemented policies came onto the national agenda and formulated. Studying how those implemented policies were put on the agenda and formulated may give additional insights into why the policies face several implementation challenges.…”

“…Over the years, policy makers at national level have formulated a wide range of public policies and programmes to increase financial and geographical access to maternal care; space child birth; provide essential obstetric care; expand midwifery coverage; and make equipment and health facilities available and many more to improve maternal health outcomes and reduce maternal deaths in Ghana (Government of Ghana, 2006, Ministry of Health, 2011b, Ministry of Health, 2007, Ministry of Health et al, 2011, Witter et al, 2009, Ofosu-Amaah, 1981.…”