Bureau of International Medical Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
Centre for Non-Communicable Diseases Research, Institute of Health Research, University of Health and Allied Sciences, P.O. Box 31, Ho, Volta Region, Ghana.
Int J Environ Res Public Health. 2023 Aug 18;20(16):6595. doi: 10.3390/ijerph20166595.
A free maternal health policy started in Ghana in 2008, however, health facility utilization is still low, and out-of-pocket payments (OOPPs) are putting households at risk of catastrophic expenditure. To improve this situation, some rural communities have assigned a midwife to a health post called community-based health planning and services (CHPS), where only assistant nurses are allocated. This study explored the effectiveness of the new approach in Upper West Region, Ghana. We conducted a cross-sectional study and interviewed women who gave birth in the last year. We systematically selected communities matched into four criteria: communities near CHPS (functional CHPS), communities near CHPS with a midwife (advanced CHPS), communities near a health centre, and communities without a health facility in their neighbourhood. In total, 534 women were interviewed: functional CHPS 104, advanced CHPS 131, near health centre 173, and no facility 126. About 78% of the women were 20 to 34 years old. About half of the women incurred OOPP, however, catastrophic payment (household spending > 5% of annual income) was significantly lower in advanced CHPS communities for normal delivery compared with the other three communities. The new local approach of assigning a midwife to CHPS functioned well, improving access to healthcare facilities for childbirth.
2008 年加纳开始实施免费的母婴健康政策，然而，卫生机构的利用率仍然很低，自费支付（OOPPs）使家庭面临灾难性支出的风险。为了改善这种情况，一些农村社区指定了一名助产士到一个名为基于社区的卫生规划和服务（CHPS）的卫生所，而只分配了助理护士。本研究探讨了加纳上西部地区这种新方法的有效性。我们进行了一项横断面研究，对去年分娩的妇女进行了访谈。我们系统地选择了符合以下四个标准的社区进行匹配：CHPS 附近的社区（功能齐全的 CHPS）、CHPS 附近有助产士的社区（先进的 CHPS）、靠近卫生中心的社区和附近没有卫生设施的社区。共有 534 名妇女接受了访谈：功能齐全的 CHPS 社区 104 名，先进的 CHPS 社区 131 名，靠近卫生中心的社区 173 名，附近没有卫生设施的社区 126 名。大约 78%的妇女年龄在 20 至 34 岁之间。大约一半的妇女自费支付，但与其他三个社区相比，先进的 CHPS 社区的正常分娩的灾难性支付（家庭支出超过年收入的 5%）明显更低。将助产士分配到 CHPS 功能的新的当地方法运作良好，改善了获得分娩医疗保健设施的机会。
