Abstract
This study investigated the implementation of the free maternal healthcare policy in Ghana with a focus on the constraints that impede the attainment of the policy’s goals. Using the qualitative approach, the case study strategy was deployed, with the New Juabeng Municipal as the case. Data was derived from multiple sources (interviews, focus group discussions and documentary reviews) and from different categories of persons (staff of health care facilities, service providers and district health insurance secretariat, beneficiaries and residents).
The study found the policy has been implemented according to plan in the New Juabeng Municipality. Several measures have been instituted by officials and these include; free registration and renewal of NHIS cards for pregnant women, free antenatal medical care, free delivery and post-delivery vaccination, regular visit of midwives of CHPS compounds to pregnant women and regular publicity and education campaigns to notify women to register and renew their NHIS cards. These have resulted in high antenatal care and reduced maternal mortality in the municipality.
In spite of the improvements however, a number of constrains were found. These include inadequate funding which led to delays in reimbursing service providers, inadequate equipment and health infrastructure, poor quality of service delivery and care at the facility-level and several other institutional bottlenecks. It was also established that weak collaboration and coordination between key partners and ministries affected the effectiveness of the policy. Also, lack of political will to provide the necessary resources to support the policy as well as undue politicization and its related issue of speaking ill of the policy by some politicians are key challenges.
On the basis of these findings, some recommendations are made to improve the system. Establishing a legal framework that will commit policy makers to provide more resources to the program, and effective linkages and interactions between MDA’s which are directly or indirectly related with the implementation of the free maternal healthcare policy came out as vital.
CHAPTER ONE GENERAL INTRODUCTION
- Introduction & Background
This study investigates the challenges of implementing the free maternal healthcare policy in Ghana, using the New Juabeng Municipal as a case. The study is in the context of increasing challenges of implementing public policies at the local level in Ghana and other developing countries (Ohemeng & Ayee 2016). Implemented as part of the National Health Insurance Scheme in 2008, the free maternal healthcare policy was to help Ghana meet the Millennium Development Goals (MDG) 4 and 5, by reducing child mortality and improving maternal healthcare. Under the program, pregnant women are to receive free full package access to antenatal, prenatal and postnatal care in all health centers throughout the country (Abdallah 2015; Dalinjong, Wang & Homer 2018).
In the period before 2007, maternal mortality in Ghana had soared to very high levels with a ratio of 450 deaths per 100,000 live births (this figure was estimated at 350 deaths per 100,000 by UN agencies/World Bank in 2010). Problems of haemorrhage, abortion, hypertensive disorders, infections and ectopic gestation were recorded as the main causes of maternal deaths in the country. The Government of Ghana’s therefore declared free maternal healthcare to deal with the problem of severe maternal mortality which had reached high levels to the point of being declared as a national emergency in 2008 (Kyei-Nimako, 2016).
The free maternal healthcare policy was therefore policy grafted out of the MDG Acceleration Framework to accord maternal health the level of urgency that it required. The objective is to
eliminate financial barriers associated with the use of services and reduce maternal as well as perinatal death. This study thus seeks to assess the implementation of the free maternal healthcare policy and the challenges faced in terms of utilization of maternal care services in Ghana after a decade of implementation.
Problem Statement
The benefits of implementing the free maternal health policy in Ghana have been widely acknowledged by scholars (Anafi et al., 2018; Dalinjong, Wang & Homer 2018). Since its implementation in Ghana, studies conducted on the policy have reported a significant positive relationship between the fee exemptions and use of services (Anafi et al., 2018; Brown et al., 2016). These studies suggest that the policy has generally been successful in providing access to mothers to deliver safely in the hospitals.
These successes notwithstanding, there are other reports that suggest that the policy is constrained in some respects. While some of the challenges emanate from the provision of adequate resources to support the policy, there is also some suspicion that the policy does not receive the adequate support from government. Studies by Koduah, van Dijk, & Agyepong (2016) for example reports of ineffectiveness of the policy with pregnant mothers still being charged various amounts in some communities. This signals challenges relating to cost of care to beneficiaries of the programme. There are also issues to do with lack of coordination and collaborations that is needed between the various agencies to enhance effectiveness (Asante et al., 2007; Bosu et al., 2007; Penfold et al., 2007; Witter et al., 2009).
Despite the signals being given of the various challenges however, only a few studies have explored these challenges and less so from a policy implementation perspective (Koduah & Agyepong 2018). Even more importantly, the few studies existing research have been conducted in other jurisdictions other than the New Juaben. Given that the outcomes of public tend to vary in different locations, it becomes imperative to examine the implementation of the policy from other regions and districts. This will not only enhance a fuller appreciation of the policy but also contribute additional knowledge on implementation of public policies in general. This study therefore explores the implementation challenges of the free maternal healthcare policy, with a focus on beneficiary and provider experiences in accessing and providing healthcare services under the policy in the New Juabeng Municipality.
Research Objectives
The overall objective of the study is to investigate the implementation challenges of the free maternal healthcare policy in the New Juabeng District. This broad objective is broken down into the following specific objectives
- To determine the extent to which the free maternal healthcare policy has been implemented in the New Juaben Municipality
- To investigate the challenges facing the municipality in implementing the free maternal healthcare policy.
- To explore possible ways of dealing with the challenges to enhance overall effectiveness in implementation
Research Questions
In order to achieve the above objectives, the following questions guided the study.
- To what extent has the free maternal healthcare policy been implemented in the New Juaben municipality?
- What are the challenges faced by the municipality in implementing the policy?
- How can these challenges be addressed to enhance the effectiveness of the policy?
