Studies have established that quality antenatal care (ANC) and facility-level delivery services provided by trained health personnel impact positively on maternal healthcare outcomes, yet recent literature in sub-Saharan Africa shows that nearly half of all childbirth occur at home with no support from the services of trained health personnel. In Ethiopia for example, while experienced birth attendants provided ANC for up to 71% of pregnant women, only 16% of pregnant women give birth under trained healthcare personnel supervision. Likewise, despite significant improvement in maternal health care delivery in Ghana, only 56% percent of pregnant women give birth under skilled supervision as of 2017.
Indeed, the World Health Organization (WHO) observed that just around 60% of pregnant women in LMICs have access to expert delivery services compared to 99% of pregnant women in high-income countries, thus requiring deliberate and concerted efforts from LMICs.
In time past, Ghana implemented full-cost recovery, popularly called “cash and carry’ between 1985 to May 1998, and later antenatal care fee exemption from June 1998 to August 2003 and subsequently, childbirth fee exemption policy from September 2003 to March 2005 (for selected regions; Northern, Upper East, Upper West and Central) and later expanded from 2005 to 2007. To address funding constraints, the fee exemption policy was scrapped in 2007 and pregnant women enrolled freely unto the then newly operationalized National Health Insurance Scheme (NHIS) without premium payment, so-called, ‘free’ maternal health care policy (FMHCP).
Author(s) Details:
John Azaare
Department of Health Service, Policy Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.
Kasim Abdulai
Department of Clinical Nutrition and Dietetics, Translational Nutrition Research Group, University of Cape Coast, Cape Coast, Ghana.
Robert Bagngmen Bio
College of Health and Well-Being, Kintampo, Ghana.
Recent Global Research Developments in Economic Impact of Maternal Delivery Fee Exemption in Ghana
The Role of Policy Actors and Contextual Factors:
A study titled “The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades” explored how and why maternal fee exemption policies have been maintained in Ghana since the introduction of a ‘free antenatal care in government facilities’ policy in 1963 [1] .
Key Points: Contextual factors (such as political ideology, economic crisis, historical events, and international agendas) shaped policy actors’ actions, maintaining the issue on the agenda. Donors also gained influence within the Ghanaian health sector.
Maternity Care Fee Exemption Policies:
Over the years, Ghana has implemented several maternal health policies, including full-cost recovery (1985-1998), antenatal care fee exemption (1998-2003), and delivery care fee exemption (initially for deprived regions, later scaled up nationally from 2005 to 2007) [2] .
Impact: While studies found limited effects on maternal deaths, fee exemption policies were associated with increased uptake of skilled birth care among the poor.
References
- Koduah, A., van Dijk, H. & Agyepong, I.A. The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health Res Policy Sys 13, 27 (2015). https://doi.org/10.1186/s12961-015-0016-9
- Azaare, J., Aninanya, G.A., Abdulai, K. et al. Maternal health care utilization following the implementation of the free maternal health care policy in Ghana: analysis of Ghana demographic and health surveys 2008–2014. BMC Health Serv Res 24, 207 (2024). https://doi.org/10.1186/s12913-024-10661-5
