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Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana

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  • Philip Ayizem Dalinjong
  • Alex Y Wang
  • Caroline S E Homer

Abstract

Introduction: The free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored. Methods: A convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women’s perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes. Results: The NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy. Conclusion: Women needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.

Suggested Citation

  • Philip Ayizem Dalinjong & Alex Y Wang & Caroline S E Homer, 2018. "Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-19, February.
    • Handle: RePEc:plo:pone00:0184830
    DOI: 10.1371/journal.pone.0184830
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    References listed on IDEAS

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    1. United Nations, 2016. "The Sustainable Development Goals 2016," Working Papers id:11456, eSocialSciences.
    2. Leone, Tiziana & James, K. S. & Padmadas, Sabu S., 2013. "The burden of maternal health care expenditure in India: multilevel analysis of national data," LSE Research Online Documents on Economics 47281, London School of Economics and Political Science, LSE Library.
    3. Eric Arthur, 2012. "Wealth and antenatal care use: implications for maternal health care utilisation in Ghana," Health Economics Review, Springer, vol. 2(1), pages 1-8, December.
    4. Priyanka Saksena & Justine Hsu & David B Evans, 2014. "Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges," PLOS Medicine, Public Library of Science, vol. 11(9), pages 1-11, September.
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    Cited by:

    1. Cherri Zhang & Md Shafiur Rahman & Md Mizanur Rahman & Alfred E Yawson & Kenji Shibuya, 2019. "Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-19, May.
    2. Sanni Yaya & Feng Da & Ruoxi Wang & Shangfeng Tang & Bishwajit Ghose, 2019. "Maternal healthcare insurance ownership and service utilisation in Ghana: Analysis of Ghana Demographic and Health Survey," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-13, April.
    3. Alem Desta Wuneh & Afework Mulugeta Bezabih & Lars Åke Persson & Yemisrach Behailu Okwaraji & Araya Abrha Medhanyie, 2022. "“If I Was Educated, I Would Call the Ambulance and Give Birth at the Health Facility”—A Qualitative Exploratory Study of Inequities in the Utilization of Maternal, Newborn, and Child Health Services i," IJERPH, MDPI, vol. 19(18), pages 1-14, September.
    4. Fosu, Prince, 2020. "The Effect of Government Expenditure and Free Maternal Health Care Policy on Household Consumption in Ghana," MPRA Paper 101551, University Library of Munich, Germany.

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