FEMHealth project, Immpact, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
Int J Equity Health. 2013 Feb 27;12:16. doi: 10.1186/1475-9276-12-16.
Pregnant women were offered free access to health care through National Health Insurance (NHIS) membership in Ghana in 2008, in the latest phase of policy reforms to ensure universal access to maternal health care. During the same year, free membership was made available to all children (under-18). This article presents an exploratory qualitative analysis of how the policy of free maternal membership was developed and how it is being implemented.
The study was based on a review of existing literature - grey and published - and on a key informant interviews (n = 13) carried out in March-June 2012. The key informants included representatives of the key stakeholders in the health system and public administration, largely at national level but also including two districts.
The introduction of the new policy for pregnant women was seen as primarily a political initiative, with limited stakeholder consultation. No costing was done prior to introduction, and no additional funds provided to the NHIS to support the policy after the first year. Guidelines had been issued but beyond collecting numbers of women registered, no additional monitoring and evaluation have yet been put in place to monitor its implementation. Awareness of the under-18 s policy amongst informants was so low that this component had to be removed from the final study. Initial barriers to access, such as pregnancy tests, were cited, but many appear to have been resolved now. Providers are concerned about the workload related to services and claims management but have benefited from increased financial resources. Users still face informal charges, and are reported to have responded differentially, with rises in antenatal care and in urban areas highlighted. Policy sustainability is linked to the survival of the NHIS as a whole.
Ghana has to be congratulated for its persistence in trying to address financial barriers. However, many themes from previous evaluations of exemptions policies in Ghana have recurred in this study - particularly, the difficulties of getting timely reimbursement to facilities, of controlling charging of patients, and of reaching the poorest. This suggests that providing free care through a national health insurance system has not solved systemic weaknesses. The wider concerns about raising the quality of care, and ensuring that all supply-side and demand-side elements are in place to make the policy effective will also take a longer term and bigger commitment.
2008 年，加纳通过国家健康保险（NHIS）会员制为孕妇提供免费医疗保健，这是确保全民获得产妇保健的最新政策改革阶段。同年，所有儿童（18 岁以下）都可免费享受会员资格。本文对免费产妇会员资格政策的制定过程及其实施情况进行了探索性的定性分析。
本研究基于对现有文献（灰色文献和已发表文献）的审查，以及 2012 年 3 月至 6 月进行的关键知情人访谈（n=13）。关键知情人包括卫生系统和公共行政部门的主要利益相关者代表，主要在国家一级，但也包括两个地区。
引入新的孕妇政策被视为主要是一项政治举措，利益相关者协商有限。在推出之前没有进行成本核算，在第一年之后也没有向 NHIS 提供额外资金来支持该政策。虽然已经发布了指导方针，但除了登记的妇女人数外，尚未采取其他监测和评估措施来监测其实施情况。知情人对 18 岁以下儿童政策的认识如此之低，以至于该部分内容不得不从最终研究中删除。最初提到了获取服务的障碍，例如妊娠测试，但现在许多障碍似乎已经得到解决。提供者担心与服务和索赔管理相关的工作量，但受益于增加的财政资源。用户仍然面临非正式收费，并报告说他们的反应不同，强调了产前护理和城市地区的增加。政策可持续性与 NHIS 作为一个整体的生存能力相关。
加纳坚持不懈地努力解决财务障碍，值得称赞。然而，本研究中再次出现了加纳以前对豁免政策评估的许多主题——特别是及时向医疗机构报销、控制向患者收费以及覆盖最贫困人群的困难。这表明，通过国家健康保险制度提供免费护理并没有解决系统中的弱点。关于提高护理质量以及确保政策有效的所有供应方和需求方要素都到位的更广泛问题也需要更长的时间和更大的承诺。
