Background: The Government of Ghana's fee exemption policy for delivery
care introduced in September 2003, aimed at reducing financial barriers
to using maternal services. This policy also aimed to increase the rate
of skilled attendance at delivery, reduce maternal and perinatal
mortality rates and contribute to reducing poverty.
Objective: To evaluate the economic outcomes of the policy on households
Methods: Central and Volta regions were selected for the study. In each
region, six districts were selected. A two stage sampling approach was
used to identify women for a household cost survey. A sample of 1500
women in Volta region (made up of 750 women each before and after the
exemption policy) and 750 women after the policy was introduced in
Outcome Measures: Household out-of-pocket payment for maternal delivery
and catastrophic out-of-pocket health payments.
Results: There was a statistically significant decrease in the mean
out-of-pocket payments for caesarean section (CS) and normal delivery at
health facilities after the introduction of the policy. The percentage
decrease was highest for CS at 28.40% followed by normal delivery at
25.80%. The incidence of catastrophic out-of-pocket payments also fell.
At lower thresholds, the incidence of catastrophic delivery payment was
concentrated more amongst the poor. For the poorest group (1st quintile)
household out-of-pocket payments in excess of 2.5% of their pre-payment
income dropped from 54.54% of the households to 46.38% after the
exemption policy. The policy had a more positive impact on the extreme
poor than the poor. The richest households (5th quintile) had a decline
in out-of-pocket payments of 21.51% while the poor households (1st
quintile) had a 13.18% decline.
Conclusions: The policy was beneficial to users of the service. However,
the rich benefited more than the poor. There is need for proper
targeting to identify the poorest of the poor before policies are
implemented to ensure maximum benefit by the target group.
Asante, F.; Chikwama, C.; Daniels, A. Armar-Klemesu, M. Evaluating the Economic Outcomes of the Policy of Fee Exemption for Maternal Delivery Care in Ghana. Ghana Medical Journal (2007) 41 (3) 110-117.
Evaluating the Economic Outcomes of the Policy of Fee Exemption for Maternal Delivery Care in Ghana