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Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?

Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?
Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor?
Objective: To investigate the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana.

Methods: Population data representing 12,288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana Demographic and Health Surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery cash and carry scheme; antenatal care fee exemption; delivery care fee exemption and the National Health Insurance Scheme. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts.

Findings: The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared to their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the ?cash and carry ?and free antenatal care policies period. The benefits during the free delivery care and ?National ?Health Insurance Scheme policy periods accrued more for the rich than the poor. ?There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors.

Conclusion: The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care.
0268-1080
Amoako Johnson, F.
e348fd15-9fe2-472f-a701-2980b8cec4d5
Frempong-Ainguah, F
5a44b2be-4ee7-4f07-b9de-955a0c9bddfc
Padmadas, S.S.
64b6ab89-152b-48a3-838b-e9167964b508
Amoako Johnson, F.
e348fd15-9fe2-472f-a701-2980b8cec4d5
Frempong-Ainguah, F
5a44b2be-4ee7-4f07-b9de-955a0c9bddfc
Padmadas, S.S.
64b6ab89-152b-48a3-838b-e9167964b508

Amoako Johnson, F., Frempong-Ainguah, F and Padmadas, S.S. (2016) Two decades of maternity care fee exemption policies in Ghana: have they benefited the poor? Health Policy and Planning, 31 (1). (doi:10.1093/heapol/czv017).

Record type: Article

Abstract

Objective: To investigate the impact of maternity-related fee payment policies on the uptake of skilled birth care amongst the poor in Ghana.

Methods: Population data representing 12,288 births between November 1990 and October 2008 from four consecutive rounds of the Ghana Demographic and Health Surveys were used to examine the impact of four major maternity-related payment policies: the full-cost recovery cash and carry scheme; antenatal care fee exemption; delivery care fee exemption and the National Health Insurance Scheme. Concentration curves were used to analyse the rich-poor gap in the use of skilled birth care by the four policy interventions. Multilevel logistic regression was used to examine the effect of the policies on the uptake of skilled birth care, adjusting for relevant predictors and clustering within communities and districts.

Findings: The uptake of skilled birth care over the policy periods for the poorest women was trivial when compared to their non-poor counterparts. The rich-poor gap in skilled birth care use was highly pronounced during the ?cash and carry ?and free antenatal care policies period. The benefits during the free delivery care and ?National ?Health Insurance Scheme policy periods accrued more for the rich than the poor. ?There exist significant differences in skilled birth care use between and within communities and districts, even after adjusting for policy effects and other relevant predictors.

Conclusion: The maternal care fee exemption policies specifically targeted towards the poorest women had limited impact on the uptake of skilled birth care.

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More information

Accepted/In Press date: 13 February 2015
e-pub ahead of print date: 9 April 2015
Published date: 1 February 2016
Organisations: Social Statistics & Demography

Identifiers

Local EPrints ID: 375307
URI: https://eprints.soton.ac.uk/id/eprint/375307
ISSN: 0268-1080
PURE UUID: e222166c-9bed-40cd-acf5-7f118654c585
ORCID for S.S. Padmadas: ORCID iD orcid.org/0000-0002-6538-9374

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Date deposited: 23 Mar 2015 10:56
Last modified: 15 Aug 2019 00:46

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Contributors

Author: F. Amoako Johnson
Author: F Frempong-Ainguah
Author: S.S. Padmadas ORCID iD

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