IDEAS home Printed from https://ideas.repec.org/p/ags/miscgh/355514.html

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

Author

Listed:
  • Doreen Anyamesem

Abstract

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.

Suggested Citation

  • Doreen Anyamesem, 2021. "Assessing Maternal Health Outcomes of Ghana’s Free Maternal Health Care Policy (FMHCP) Under the National Health Insurance Scheme," Miscellaneous Publications 355514, University of Ghana, Institute of Statistical Social & Economic Research (ISSER).
    • Handle: RePEc:ags:miscgh:355514
    DOI: 10.22004/ag.econ.355514
    as

    Download full text from publisher

    File URL: https://ageconsearch.umn.edu/record/355514/files/PhD_2021_Doreen_Anyamesem.pdf
    Download Restriction: no
    File URL: https://libkey.io/10.22004/ag.econ.355514?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. 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.
    2. Powell-Jackson, Timothy & Mazumdar, Sumit & Mills, Anne, 2015. "Financial incentives in health: New evidence from India's Janani Suraksha Yojana," Journal of Health Economics, Elsevier, vol. 43(C), pages 154-169.
    3. Saifuddin Ahmed & Andreea A Creanga & Duff G Gillespie & Amy O Tsui, 2010. "Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-6, June.
    4. Sonja Merten & Adriane Martin Hilber & Christina Biaggi & Florence Secula & Xavier Bosch-Capblanch & Pem Namgyal & Joachim Hombach, 2015. "Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-19, August.
    5. Ganle, John Kuumuori & Afriyie, Kwadwo & Segbefia, Alexander Yao, 2015. "Microcredit: Empowerment and Disempowerment of Rural Women in Ghana," World Development, Elsevier, vol. 66(C), pages 335-345.
    6. Altman, Molly R. & Oseguera, Talita & McLemore, Monica R. & Kantrowitz-Gordon, Ira & Franck, Linda S. & Lyndon, Audrey, 2019. "Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    7. Powell-Jackson, Timothy & Hanson, Kara, 2012. "Financial incentives for maternal health: Impact of a national programme in Nepal," Journal of Health Economics, Elsevier, vol. 31(1), pages 271-284.
    8. 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.
    9. Ensor, Tim & Chhun, Chhim & Kimsun, Ton & McPake, Barbara & Edoka, Ijeoma, 2017. "Impact of health financing policies in Cambodia: A 20 year experience," Social Science & Medicine, Elsevier, vol. 177(C), pages 118-126.
    10. Gihoon Hong & Soyoung Kim & Geunhwan Park & Seung-Gyu Sim, 2019. "Female Education Externality and Inclusive Growth," Sustainability, MDPI, vol. 11(12), pages 1-12, June.
    11. Santosh Kumar & Emily A. Dansereau & Christopher J. L. Murray, 2014. "Does distance matter for institutional delivery in rural India?," Applied Economics, Taylor & Francis Journals, vol. 46(33), pages 4091-4103, November.
    12. William Hovey, 2000. "The Worst Of Both Worlds: Nursing Home Regulation In The United States," Review of Policy Research, Policy Studies Organization, vol. 17(4), pages 43-59, December.
    13. Susie Dzakpasu & Seyi Soremekun & Alexander Manu & Guus ten Asbroek & Charlotte Tawiah & Lisa Hurt & Justin Fenty & Seth Owusu-Agyei & Zelee Hill & Oona M R Campbell & Betty R Kirkwood, 2012. "Impact of Free Delivery Care on Health Facility Delivery and Insurance Coverage in Ghana’s Brong Ahafo Region," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-9, November.
    14. Yoko Akachi & Margaret E. Kruk, 2017. "Quality of care: Measuring a neglected driver of improved health," WIDER Working Paper Series wp-2017-135, World Institute for Development Economic Research (UNU-WIDER).
    15. Richard Agbanyo, 2020. "Ghana's national health insurance, free maternal healthcare and facility‐based delivery services," African Development Review, African Development Bank, vol. 32(1), pages 27-41, March.
    16. Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    17. Felix Masiye & Oliver Kaonga & Joses M Kirigia, 2016. "Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-15, January.
    18. Maine, D. & Rosenfield, A., 1999. "The safe motherhood initiative: Why has it stalled?," American Journal of Public Health, American Public Health Association, vol. 89(4), pages 480-482.
    19. Nazmul Alam & Mohammad Hajizadeh & Alexandre Dumont & Pierre Fournier, 2015. "Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-16, April.
    20. 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.
    21. Yoko Akachi & Margaret E. Kruk, 2017. "Quality of care: Measuring a neglected driver of improved health," WIDER Working Paper Series 135, World Institute for Development Economic Research (UNU-WIDER).
    22. 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.
    23. Kai Liu & Benjamin Cook & Chunling Lu, 2019. "Health inequality and community-based health insurance: a case study of rural Rwanda with repeated cross-sectional data," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(1), pages 7-14, January.
    24. Paolo Brunori & Flaviana Palmisano & Vitorocco Peragine, 2019. "Inequality of opportunity in sub-Saharan Africa," Applied Economics, Taylor & Francis Journals, vol. 51(60), pages 6428-6458, December.
    25. Handler, A. & Issel, M. & Turnock, B., 2001. "A conceptual framework to measure performance of the public health system," American Journal of Public Health, American Public Health Association, vol. 91(8), pages 1235-1239.
    26. Ama Pokuaa Fenny & Derek Asuman & Aba Obrumah Crentsil & Doreen Nyarko Anyamesem Odame, 2019. "Trends and causes of socioeconomic inequalities in maternal healthcare in Ghana, 2003–2014," International Journal of Social Economics, Emerald Group Publishing Limited, vol. 46(2), pages 288-308, February.
    27. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
    28. Lenka Benova & Ann-Beth Moller & Allisyn C Moran, 2019. "“What gets measured better gets done better”: The landscape of validation of global maternal and newborn health indicators through key informant interviews," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-16, November.
    29. Henry Mensah & Kofi Akuoko & Florence Ellis, 2016. "An Empirical Assessment of Health Workers’ Organisational Commitment in Ghana: A Comparative Analysis," International Journal of Business and Management, Canadian Center of Science and Education, vol. 11(3), pages 183-183, February.
    30. 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.
    31. Boniface Ayanbekongshie Ushie & Ekerette Emmanuel Udoh & Anthony Idowu Ajayi, 2019. "Examining inequalities in access to delivery by caesarean section in Nigeria," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-16, August.
    Full references (including those not matched with items on IDEAS)

    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. Anyamesem, Doreen, 2021. "Assessing Maternal Health Outcomes of Ghana’s Free Maternal Health Care Policy (FMHCP) Under the National Health Insurance Scheme," Miscellaneous Publications 358816, University of Ghana, Institute of Statistical Social & Economic Research (ISSER).
    2. Rahman, Mohammad Mahbubur & Pallikadavath, Saseendran, 2018. "How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India," Economics & Human Biology, Elsevier, vol. 31(C), pages 164-183.
    3. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.
    4. Hubert Amu & Abdul-Aziz Seidu & Ebenezer Agbaglo & Robert Kokou Dowou & Edward Kwabena Ameyaw & Bright Opoku Ahinkorah & Kwaku Kissah-Korsah, 2021. "Mixed effects analysis of factors associated with health insurance coverage among women in sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-15, March.
    5. Weitzman, Abigail, 2017. "The effects of women's education on maternal health: Evidence from Peru," Social Science & Medicine, Elsevier, vol. 180(C), pages 1-9.
    6. Tulasi Malini Maharatha & Sumirtha Gandhi & Umakant Dash, 2021. "Has the Demand and Supply-side Components of Janani Suraksha Yojana Augmented the Uptake of Maternal Health Care Services among Poor Women in India ? : An Application of Hybrid Matching Technique," BASE University Working Papers 08/2021, BASE University, Bengaluru, India.
    7. Habtamu Tolera & Tegegne Gebre-Egziabher & Helmut Kloos, 2020. "Using Andersen’s behavioral model of health care utilization in a decentralized program to examine the use of antenatal care in rural western Ethiopia," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.
    8. von Haaren, Paula & Klonner, Stefan, 2020. "Maternal cash for better child health? The impacts of India’s IGMSY/PMMVY maternity benefit scheme," Working Papers 0689, University of Heidelberg, Department of Economics.
    9. 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.
    10. Fredrick Manang & Chikako Yamauchi, 2015. "The impact of access to health facilities on maternal care use and health status: Evidence from longitudinal data from rural Uganda," GRIPS Discussion Papers 15-19, National Graduate Institute for Policy Studies.
    11. Cynthia K. Stanton, 2004. "Methodological Issues in the Measurement of Birth Preparedness in Support of Safe Motherhood," Evaluation Review, , vol. 28(3), pages 179-200, June.
    12. 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.
    13. Nathanael Ojong, 2019. "Healthcare Financing in Rural Cameroon," Societies, MDPI, vol. 9(4), pages 1-12, November.
    14. Doke, Theresa Enyonam Adzo, 2021. "Health Financing in Ghana: The Role of Microfinance Institutions in Reducing Health Risks," Miscellaneous Publications 358793, University of Ghana, Institute of Statistical Social & Economic Research (ISSER).
    15. Lefebvre, Bertrand & Mukhopadhyay, Abhiroop & Ratra, Vastav, 2025. "Who bears the distance cost of public primary healthcare? Hypertension among the elderly in rural India," Social Science & Medicine, Elsevier, vol. 366(C).
    16. Lisa Cameron & Diana Contreras Suarez & Katy Cornwell, 2019. "Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-18, June.
    17. 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.
    18. Nazmul Alam & Mohammad Hajizadeh & Alexandre Dumont & Pierre Fournier, 2015. "Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-16, April.
    19. Sarkar, Nandini D.P. & Bunders-Aelen, Joske & Criel, Bart, 2018. "The complex challenge of providing patient-centred perinatal healthcare in rural Uganda: A qualitative enquiry," Social Science & Medicine, Elsevier, vol. 205(C), pages 82-89.
    20. 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.

    More about this item

    Keywords

    ;

    Statistics

    Access and download statistics

    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:ags:miscgh:355514. 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: AgEcon Search (email available below). General contact details of provider: https://edirc.repec.org/data/issergh.html .

    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.