Evaluation of the delivery-fee-exemption policy in Ghana: population estimates of changes in delivery service utilisation in two regions

Suzanne Penfold, E Harrison, Jacqueline Bell, Ann Fitzmaurice

Research output: Contribution to journalArticle

Abstract

Objectives

To determine changes in the proportion of deliveries at health facilities and the proportion attended by health professionals after delivery fee exemption implementation.

Design

Pre and post intervention implementation cluster-sampled household survey.

Setting

Central and Volta regions of Ghana.

Participants

Women who had delivered in these regions during the fee exemption policy and an equivalent period of time prior to it.

Main outcome measures

Place of delivery and person attending.

Results

After fee exemption implementation the likelihood of delivering in a health facility increased significantly in Central (OR 1.83, p<0.001) and Volta (OR 1.34, p<0.05) regions when accounting for the mothers' education and poverty levels and the clustered data. Results from Central Region showed increases in facility deliveries mainly occurred in health centres (from 13.7% to 22.3% of deliveries), and were attended by midwives (from 49.0% to 59.7%). There was evidence that after implementation some inequalities in the uptake of facility deliveries decreased. The greatest increase in the proportion of deliveries taking place in facilities occurred among women with the lowest levels of education (Central Region) and wealth (Volta Region). These changes reduced the differentials observed.

Conclusions

After the implementation of fee exemption the proportion of deliveries in health facilities increased in both regions. Although changes cannot be directly attributed to delivery fee exemption, results demonstrating that the greatest increases in facility-based deliveries occurred among the poorest and least educated women are consistent with the expectation that the policy would particularly benefit women with the greatest financial barrier to health care and at the greatest risk of maternal mortality.
Original languageEnglish
Pages (from-to)100-109
Number of pages10
JournalGhana Medical Journal
Volume41
Issue number3
Publication statusPublished - Sep 2007

Fingerprint

Ghana
Fees and Charges
Health Facilities
Population
Education
Maternal Mortality
Health
Midwifery
Poverty
Mothers
Delivery of Health Care

Keywords

  • women's health
  • delivery service utilization
  • fee exemption
  • programme evaluation

Cite this

Evaluation of the delivery-fee-exemption policy in Ghana : population estimates of changes in delivery service utilisation in two regions. / Penfold, Suzanne; Harrison, E; Bell, Jacqueline; Fitzmaurice, Ann.

In: Ghana Medical Journal, Vol. 41, No. 3, 09.2007, p. 100-109.

Research output: Contribution to journalArticle

Penfold, Suzanne ; Harrison, E ; Bell, Jacqueline ; Fitzmaurice, Ann. / Evaluation of the delivery-fee-exemption policy in Ghana : population estimates of changes in delivery service utilisation in two regions. In: Ghana Medical Journal. 2007 ; Vol. 41, No. 3. pp. 100-109.
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N2 - ObjectivesTo determine changes in the proportion of deliveries at health facilities and the proportion attended by health professionals after delivery fee exemption implementation.DesignPre and post intervention implementation cluster-sampled household survey.SettingCentral and Volta regions of Ghana.ParticipantsWomen who had delivered in these regions during the fee exemption policy and an equivalent period of time prior to it.Main outcome measuresPlace of delivery and person attending.ResultsAfter fee exemption implementation the likelihood of delivering in a health facility increased significantly in Central (OR 1.83, p<0.001) and Volta (OR 1.34, p<0.05) regions when accounting for the mothers' education and poverty levels and the clustered data. Results from Central Region showed increases in facility deliveries mainly occurred in health centres (from 13.7% to 22.3% of deliveries), and were attended by midwives (from 49.0% to 59.7%). There was evidence that after implementation some inequalities in the uptake of facility deliveries decreased. The greatest increase in the proportion of deliveries taking place in facilities occurred among women with the lowest levels of education (Central Region) and wealth (Volta Region). These changes reduced the differentials observed.ConclusionsAfter the implementation of fee exemption the proportion of deliveries in health facilities increased in both regions. Although changes cannot be directly attributed to delivery fee exemption, results demonstrating that the greatest increases in facility-based deliveries occurred among the poorest and least educated women are consistent with the expectation that the policy would particularly benefit women with the greatest financial barrier to health care and at the greatest risk of maternal mortality.

AB - ObjectivesTo determine changes in the proportion of deliveries at health facilities and the proportion attended by health professionals after delivery fee exemption implementation.DesignPre and post intervention implementation cluster-sampled household survey.SettingCentral and Volta regions of Ghana.ParticipantsWomen who had delivered in these regions during the fee exemption policy and an equivalent period of time prior to it.Main outcome measuresPlace of delivery and person attending.ResultsAfter fee exemption implementation the likelihood of delivering in a health facility increased significantly in Central (OR 1.83, p<0.001) and Volta (OR 1.34, p<0.05) regions when accounting for the mothers' education and poverty levels and the clustered data. Results from Central Region showed increases in facility deliveries mainly occurred in health centres (from 13.7% to 22.3% of deliveries), and were attended by midwives (from 49.0% to 59.7%). There was evidence that after implementation some inequalities in the uptake of facility deliveries decreased. The greatest increase in the proportion of deliveries taking place in facilities occurred among women with the lowest levels of education (Central Region) and wealth (Volta Region). These changes reduced the differentials observed.ConclusionsAfter the implementation of fee exemption the proportion of deliveries in health facilities increased in both regions. Although changes cannot be directly attributed to delivery fee exemption, results demonstrating that the greatest increases in facility-based deliveries occurred among the poorest and least educated women are consistent with the expectation that the policy would particularly benefit women with the greatest financial barrier to health care and at the greatest risk of maternal mortality.

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