Utilization of maternal health facilities: evaluating the impact of the 2003 fee exemption policy in Ghana

Kate Jowett, University of Southampton
Zoe Matthews, University of Southampton

Despite a 20 year history of maternal health strategy, Ghana’s maternal mortality rate remains high at 560 deaths per 100,000 live births, with over half of all women still giving birth at home (DHS 2003) Due to the spatial and socio-economic disparities in maternal mortality rates, Ghana introduced a fee exemption policy in 2003 into its four poorest regions, exempting women from paying charges to give birth at a health facility. The policy aimed to increase utilization rates at health facilities, particularly for the poorest members of society who have much lower access rates. This study examined the effects the policy had upon the use of health facilities, and whether it achieved its stated aims. The Ghana Maternal Health Survey (2007) was analyzed using a combination of exploratory statistics and binary logistic regression modeling. Patterns of service use could be explored, significant variables associated with service use identified, as well as establishing whether the policy had a statistically significant effect on women’s chances of giving birth in a health facility. The results showed the policy had a significant effect – institutional births increased from 48% to 60%, with skilled birth attendance trends following a similar pattern. The presence of the policy seemed to avert the decline noted in the remaining 6 regions, where institutional births declined from 70.1% in 2003 to 59.1% in 2007. The poorest wealth quintiles who received the policy increased their utilization rates by 12.5% (2003 to 2005), whereas the rates for the poor without the policy steadily declined. However the policy’s success was short lived, as unsustainable funding meant the policy ended in 2005 - and subsequently rates of skilled birth attendance showed evidence of reversal. The study highlights the important role that fee exemption policies can play in improving rates of skilled attendance at birth.