Assessing Maternal Health Outcomes of Ghana’s Free Maternal Health Care Policy (FMHCP) Under the National Health Insurance Scheme

Maternal health is a key indicator of human development since it translates into the wellbeing of the entire household. For this reason, issues about maternal health and its outcomes remain a critical topic in development discussions. Ghana like many other Sub-Saharan African countries, encounters persistent maternal health challenges, with very slow progress towards improved outcomes. Most of these challenges are as a result of delayed or poor management of complications that come up during pregnancy, delivery or the postnatal period. For this reason, investing into strategies to increase access to care and the quality of care has been explained as a major step in improving overall postpartum outcomes. In 2008, the government of Ghana instituted the Free Maternal Health Care Policy (FMHCP) under the National Health Insurance Scheme (NHIS). The FMHCP was aimed at increasing and improving access to maternal health services, by exempting pregnant women from paying the insurance premium for the NHIS. The overall objective of the policy was to improve maternal health outcomes in Ghana. Though several studies have shown the impact of the policy on the economic and neonatal outcomes in Ghana, there is very little information on the outcome of the FMHCP on quality of care as well as health outcomes of women. To fill this gap, this study set out to assess the maternal health outcomes of the FMHCP by assessing the effect of the FMHCP on quality antenatal care in Ghana, examining the effect of the FMHCP on maternal postpartum outcomes, and lastly to examine and describe the experiences and perspectives of beneficiaries on the effect of the FMHCP on their health outcomes. The study was guided by a mixed method approach with data from the Ghana Demographic and Health Survey (GDHS) and qualitative data from interviews. Logistic regression models were used for the quantitative analysis, and a thematic analysis approach for the qualitative study. The results from the study showed significant improvements in access to quality ANC in Ghana after the implementation of the FMHCP, but at the same time revealed that there are still inequities in access to quality ANC which are fuelled by the underlying socioeconomic characteristics of individuals, specifically women. The study again showed that progress to reduce delivery and postpartum complications have remained insignificant because despite the operations of the FMHCP, there are some 21.42% women who still deliver at home without skilled care. Also, beneficiaries recounted improvements in their health outcomes and attributed this to the increase in access to quality care. Respondents however confirmed that though the FMHCP has eliminated direct cost of care, there are other indirect costs associated with maternal health care that create inequalities in access and utilisation. An important recommendation from this study is that maternal health interventions should not only focus on eliminating direct cost of maternal health services, but should also seek to address indirect costs and also socioeconomic and demographic characteristics that contribute to inequities in access and utilisation of maternal health services. This approach may yield better outcomes because factors that affect maternal health are multifaceted and any effective intervention should target each of these factors be it individual, community or institutional. Again, the study recommends that evaluation of maternal health policies should look beyond the policy variable to include all other factors that are likely to affect access and utilisation. Inclusion of relevant variables that affect access and utilisation of healthcare will give a comprehensive picture about the effect of the policy in different conditions.