IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v7y2017i1d10.1186_s13561-017-0180-4.html
   My bibliography  Save this article

The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana

Author

Listed:
  • Philip Ayizem Dalinjong

    (Faculty of Health, University of Technology Sydney)

  • Alex Y. Wang

    (Faculty of Health, University of Technology Sydney)

  • Caroline S. E. Homer

    (Faculty of Health, University of Technology Sydney)

Abstract

Background To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality. Costs were taken from the perspective of women. Methods Quantitative and qualitative data collection techniques were used in a convergent parallel mixed methods study. The study used structured questionnaire (n = 353) and focus group discussions (FGDs =7) to collect data from women who gave birth in health facilities. Quantitative data from the questionnaire were analysed, using descriptive statistics. Qualitative data from the FGDs were recorded, transcribed and analysed to determine common themes. Results The overall mean OOP payments during childbirth was GH¢33.50 (US$17), constituting 5.6% of the average monthly household income. Over one-third (36%, n = 145) of women incurred OOP payments which exceeded 10% of average monthly household income (potentially catastrophic). Sixty-nine percent (n = 245) of the women perceived that the NHIS did not cover all expenses incurred during childbirth; which was confirmed in the FGDs. Both survey and FGDs demonstrated that women made OOP payments for drugs and other supplies. The FGDs showed women bought disinfectants, soaps, rubber pads and clothing for newborns as well. Seventy-five percent (n = 264) of the women used savings, but 19% had to sell assets to finance the payments; this was supported in the FGDs. Conclusion The NHIS policy has not eliminated financial barriers associated with childbirth which impacts the welfare of some women. Women continued to make OOP payments, largely as a result of a delay in reimbursement by the NHIS. There is need to re-examine the reimbursement system in order to prevent shortage of funding to health facilities and thus encourage skilled attendance for the reduction of maternal deaths as well as the achievement of universal health coverage.

Suggested Citation

  • Philip Ayizem Dalinjong & Alex Y. Wang & Caroline S. E. Homer, 2017. "The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana," Health Economics Review, Springer, vol. 7(1), pages 1-9, December.
    • Handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0180-4
    DOI: 10.1186/s13561-017-0180-4
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-017-0180-4
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-017-0180-4?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Agar Brugiavini & Noemi Pace, 2016. "Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care," Health Economics Review, Springer, vol. 6(1), pages 1-10, December.
    2. Karima Saleh, 2013. "The Health Sector in Ghana : A Comprehensive Assessment," World Bank Publications - Books, The World Bank Group, number 12297.
    3. V. Ridde & I. Agier & A. Jahn & O. Mueller & J. Tiendrebéogo & M. Yé & M. De Allegri, 2015. "The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 55-64, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Maxwell Ayindenaba Dalaba & Paul Welaga & Abraham Oduro & Laata Latif Danchaka & Chieko Matsubara, 2018. "Cost of malaria treatment and health seeking behaviour of children under-five years in the Upper West Region of Ghana," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-14, April.
    2. Maxwell Tii Kumbeni & Agani Afaya & Paschal Awingura Apanga, 2023. "An assessment of out of pocket payments in public sector health facilities under the free maternal healthcare policy in Ghana," Health Economics Review, Springer, vol. 13(1), pages 1-7, December.
    3. Stacey Orangi & Angela Kairu & Joanne Ondera & Boniface Mbuthia & Augustina Koduah & Boniface Oyugi & Nirmala Ravishankar & Edwine Barasa, 2021. "Examining the implementation of the Linda Mama free maternity program in Kenya," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2277-2296, November.
    4. Katrina Perehudoff & Ivan Demchenko & Nikita V. Alexandrov & David Brutsaert & Angela Ackon & Carlos E. Durán & Faris El-Dahiyat & Firdaus Hafidz & Rezwan Haque & Rabia Hussain & Roderick Salenga & Fa, 2020. "Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries," IJERPH, MDPI, vol. 17(24), pages 1-30, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Robert Teye Plahar & Dai Baozhen & Abubakar Saddiqque & Sandra Asantewaa Mensah, 2020. "Experiences of the Insured and Non-Insured of the NHIS in Accessing Health-care in Tema, Ghana," Journal of Public Administration and Governance, Macrothink Institute, vol. 10(1), pages 8699-8699, December.
    2. Padmore Adusei Amoah & Joseph Edusei & David Amuzu, 2018. "Social Networks and Health: Understanding the Nuances of Healthcare Access between Urban and Rural Populations," IJERPH, MDPI, vol. 15(5), pages 1-15, May.
    3. Derek Asuman & Charles Godfred Ackah & Ulrika Enemark, 2018. "Inequalities in child immunization coverage in Ghana: evidence from a decomposition analysis," Health Economics Review, Springer, vol. 8(1), pages 1-13, December.
    4. International Food Policy Research Institute (IFPRI), 2016. "Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030," IFPRI books, International Food Policy Research Institute (IFPRI), number 978-0-89629-584-1.
    5. Robert Kaba Alhassan & Edward Nketiah-Amponsah & Daniel Kojo Arhinful, 2016. "A Review of the National Health Insurance Scheme in Ghana: What Are the Sustainability Threats and Prospects?," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-16, November.
    6. Emily Gustafsson-Wright & Gosia Popławska & Zlata Tanović & Jacques Gaag, 2018. "The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 221-276, September.
    7. Darkwah, Frank, 2022. "Does free health insurance improve health care use and labour market outcomes of the elderly in Ghana?," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    8. Maia Sieverding & Cynthia Onyango & Lauren Suchman, 2018. "Private healthcare provider experiences with social health insurance schemes: Findings from a qualitative study in Ghana and Kenya," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-22, February.
    9. Phuong Hung Vu & Ardeshir Sepehri & Linh Thi Thuy Tran, 2023. "Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam’s Household Living Standard Survey 2006–2018," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 237-254, June.
    10. Veronica Vargas & Sayem Ahmed & Alayne M Adams, 2018. "Factors enabling comprehensive maternal health services in the benefits package of emerging financing schemes: A cross-sectional analysis from 1990 to 2014," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-15, September.
    11. Meike Irene Nakovics & Stephan Brenner & Paul Jacob Robyn & Ludovic Deo Gracias Tapsoba & Manuela De Allegri, 2019. "Determinants of individual healthcare expenditure: A cross‐sectional analysis in rural Burkina Faso," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1478-1494, October.
    12. Marion Ravit & Andrainolo Ravalihasy & Martine Audibert & Valery Ridde & Emmanuel Bonnet & Bertille Raffalli & Flore-Apolline Roy & Anais N’landu & Alexandre Dumont, 2020. "The impact of the obstetrical risk insurance scheme in Mauritania on maternal healthcare utilization: a propensity score matching analysis," Post-Print hal-02509190, HAL.
    13. Abdul-Gafaru Abdulai, 2018. "The political economy of maternal healthcare in Ghana," Global Development Institute Working Paper Series esid-107-18, GDI, The University of Manchester.
    14. Parmar, Divya & Banerjee, Aneesh, 2019. "How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal," Social Science & Medicine, Elsevier, vol. 241(C).
    15. Agar Brugiavini & Noemi Pace, 2016. "Extending health insurance in Ghana: effects of the National Health Insurance Scheme on maternity care," Health Economics Review, Springer, vol. 6(1), pages 1-10, December.
    16. Mladovsky, Philipa & Ba, Maymouna, 2017. "Removing user fees for health services: A multi-epistemological perspective on access inequities in Senegal," Social Science & Medicine, Elsevier, vol. 188(C), pages 91-99.
    17. Yohan Renard, 2022. "From fees to free: User fee removal, maternal health care utilization and child health in Zambia," Post-Print hal-04216814, HAL.
    18. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    19. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    20. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0180-4. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.