Delivery-fee-exemption policy increase utilisation of services

Accra, April 26, GNA - Research findings of Ghana's policy on Delivery-Fee-Exemption has shown an increase in utilisation of delivery case services and decrease in maternal deaths in health facilities. The fee-exemption policy, which was implemented in 2003, also encouraged women to seek health care at facilities earlier in labour than before, making it easier to manage complications, the findings released at a workshop in Accra on Wednesday said.

Although the increase in the number of clients stretched resources, the providers reported drugs that were needed were available. The Research conducted by Noguchi Memorial Research into Medical Research in collaboration with the Ghana Health Service formed part of the Initiative for Maternal Mortality Programme Assessment (IMMPACT). It was to examine the implementation of the policy, assess whether the removal of the delivery fees led to more deliveries in health facilities, evaluate the consequences of the policy and quantify the effects on costs of removing delivery fees to households and the health system.

Dr. Margaret Armar-Klemesu, Country Director of IMMPACT, Ghana, giving the background of the research at the dissemination workshop said the evaluation conducted in six districts in the Central and Volta regions from November 2005 to November 2006 realised that despite the positive impact it created, quality of service did not improve during the implementation of the policy.

"Over all, quality of care was poor prior to the implementation of the delivery-fee-exemption policy and remained so after the new policy took effect and remained unchanged," she added.

Government in 2003 implemented a new policy that removed delivery fees in health facilities in four most deprived regions - Central Region and the three northern regions (Upper East, Upper West and Northern) - to improve maternal health and survival.

It was also to ensure that more births took place in health facilities and in the hands of skilled providers rather than at home with less skilled or no help.

Less than two years after the pilot study in these four regions, the policy was extended to the rest of the country, removing delivery fee in all public, private and mission facilities. Dr Armar-Klemesu noted that though the policy was successfully implemented, it suffered erratic inflow of funds that virtually led to its collapse.

She said removing the single financial barrier of payment for delivery care was not likely to have a large impact on maternal mortality.

Dr Daniel Arhinful, also of IMMPACT, Ghana, said though skilled care providers and community members perceived the policy as favourable and acceptable, some women, especially non-users of the facility had mistrust about it.

Bad attitudes of some midwives during labour restrained many women from using the facility care, whilst the increased utilisation increased in workload.

Dr Arhinful said geographical and cultural barriers were very crucial and needed to be addressed, adding that midwives and other health care providers in public health systems needed to change their attitudes towards users if skilled care for all were to become a reality.

The findings recommended that, to reduce maternal deaths and allow more women and families to choose delivery in health care facilities, other barriers such as long distances over difficult roads, transportation and drug costs as well as cultural factors needed to be addressed.

"There is an urgent need to budget adequately for implementation and improve monitoring of cash flow to regions to strengthen the entire delivery-fee-exemption policy," Dr Arhinful said. 26 April 07