Department of Health Policy Planning and Management, University of Ghana School of Public Health, Legon, Accra, Ghana.
Department of Biostatistics, University of Ghana School Public Health, Legon, Accra, Ghana.
Reprod Health. 2020 Oct 30;17(1):169. doi: 10.1186/s12978-020-01011-9.
Ghana introduced what has come to be known as the 'Free' Maternal Health Care Policy (FMHCP) in 2008 via the free registration of pregnant women to the National Health Insurance Scheme to access healthcare free of charge. The policy targeted every pregnant woman in Ghana with a full benefits package covering comprehensive maternal healthcare.
This study seeks to measure the contribution of the FMHCP to maternal healthcare utilization; antenatal care uptake, and facility delivery and determine the utilization impact on stillbirth, perinatal, and neonatal deaths using quasi-experimental methods. The study will also contextualize the findings against funding constraints and operational bottlenecks surrounding the policy operations in the Upper East Region of Ghana.
This study adopts a mixed-method design to estimate the treatment effect using variables generated from historical data of Ghana and Kenya Demographic and Health Survey data sets of 2008/2014, as treatment and comparison groups respectively. As DHS uses complex design, weighting will be applied to the data sets to cater for clustering and stratification at all stages of the analysis by setting the data in STATA and prefix Stata commands with 'svy'. Thus, the policy impact will be determined using quasi-experimental designs; propensity score matching, and difference-in-differences methods. Prevalence, mean difference, and test of association between outcome and exposure variables will be achieved using the Rao Scot Chi-square. Confounding variables will be adjusted for using Poisson and multiple logistics regression models. Statistical results will be reported in proportions, regression coefficient, and risk ratios. This study then employs intrinsic-case study technique to explore the current operations of the 'free' policy in Ghana, using qualitative methods to obtain primary data from the Upper East Region of Ghana for an in-depth analysis.
The study discussions will show the contributions of the 'free' policy towards maternal healthcare utilization and its performance towards stillbirth, perinatal and neonatal healthcare outcomes. The discussions will also centre on policy designs and implementation in resource constraints settings showing how SDG3 can be achievement or otherwise. Effectiveness of policy proxy and gains in the context of social health insurance within a broader concept of population health and economic burden will also be conferred.
This study protocol is registered for implementation by the Ghana Health Service Ethical Review Committee, number: GHS-ERC 002/04/19.
加纳于 2008 年通过为孕妇免费注册国家健康保险计划，推出了所谓的“免费”产妇保健政策（FMHCP），以免费获得医疗保健。该政策针对加纳的每一位孕妇，提供全面的产妇保健福利套餐。
本研究旨在通过准实验方法衡量 FMHCP 对产妇保健利用的贡献，包括产前保健的利用、医疗机构分娩，并确定其对死产、围产期和新生儿死亡的利用影响。该研究还将根据加纳上东部地区围绕政策运作的资金限制和运营瓶颈，对研究结果进行背景分析。
本研究采用混合方法设计，使用加纳历史数据和肯尼亚人口与健康调查数据集（2008/2014 年）生成的变量，分别作为治疗组和对照组，估计治疗效果。由于 DHS 采用复杂的设计，将对数据集进行加权，以在分析的所有阶段考虑聚类和分层，方法是在 STATA 中设置数据集，并在 Stata 命令前加上“svy”。因此，将使用准实验设计、倾向评分匹配和差异中的差异方法来确定政策影响。使用 Rao Scot Chi-square 检验将实现结局和暴露变量之间的患病率、均值差异和关联检验。将使用泊松和多逻辑回归模型调整混杂变量。统计结果将以比例、回归系数和风险比报告。本研究还采用内在案例研究技术，使用定性方法从加纳上东部地区获取原始数据，对加纳“免费”政策的当前运作情况进行深入分析。
研究讨论将展示“免费”政策对产妇保健利用的贡献及其在死产、围产期和新生儿保健结局方面的表现。讨论还将集中在资源有限背景下的政策设计和实施，展示如何实现或否则实现可持续发展目标 3。还将讨论在更广泛的人口健康和经济负担概念内的社会健康保险政策代理的有效性和收益。
本研究方案已由加纳卫生服务伦理审查委员会注册实施，编号：GHS-ERC 002/04/19。
