Department of Health Service, Policy Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.
Translational Nutrition Research Group, Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana.
BMC Health Serv Res. 2024 Feb 15;24(1):207. doi: 10.1186/s12913-024-10661-5.
In July 2008, Ghana introduced a 'free' maternal health care policy (FMHCP) through the national health insurance scheme (NHIS) to provide comprehensive antenatal, delivery and post-natal care services to pregnant women. In this study, we evaluated the 'free' policy impact on antenatal care uptake and facility-level delivery utilization since the policy inception.
The study used two rounds of repeated cross-sectional data from the Ghana Demographic and Health Survey (GDHS, 2008-2014) and constructed exposure variable of the FMHCP using mothers' national health insurance status as a proxy variable and another group of mothers who did not subscribe to the policy. We then generated the propensity scores of the two groups, ex-post, and matched them to determine the impact of the 'free' maternal health care policy as an intervention on antenatal care uptake and facility-level delivery utilization, using probit and logit models.
Antenatal care uptake and facility-level delivery utilization increased by 8 and 13 percentage points difference, observed coefficients; 0.08; CI: 95% [0.06-0.10]; p < 0.001 and 0.13; CI: 95% [0.11-0.15], p < 0.001, respectively. Pregnant women were 1.97 times more likely to make four plus [a WHO recommended number of visits at the time] antenatal care visits and 1.87 times more likely to give birth in a health care facility of any level in Ghana between 2008 and 2104; aOR = 1.97; CI: 95% [1.61-2.4]; p < 0.001 and aOR = 1.87; CI: 95% [1.57-2.23]; p < 0.001, respectively.
Antenatal care uptake and facility-level delivery utilization improved significantly in Ghana indicating a positive impact of the FMHCP on maternal health care utilization in Ghana since its implementation.
2008 年 7 月，加纳通过国家健康保险计划（NHIS）推出了一项“免费”产妇保健政策（FMHCP），为孕妇提供全面的产前、分娩和产后护理服务。在这项研究中，我们评估了该政策自实施以来对产前保健利用率和医疗机构分娩利用率的影响。
本研究使用两轮加纳人口与健康调查（GDHS，2008-2014 年）的重复横断面数据，使用母亲的国家健康保险状况作为代理变量来构建 FMHCP 的暴露变量，并使用另一组未参加该政策的母亲作为对照组。然后，我们生成两组的倾向得分，进行事后匹配，以确定“免费”产妇保健政策作为干预措施对产前保健利用率和医疗机构分娩利用率的影响，使用概率单位和对数模型。
产前保健利用率和医疗机构分娩利用率分别增加了 8 和 13 个百分点，观察到的系数分别为 0.08；95%CI：[0.06-0.10]；p<0.001 和 0.13；95%CI：[0.11-0.15]；p<0.001。在加纳，2008 年至 2014 年间，孕妇进行四次及以上产前保健就诊的可能性增加了 1.97 倍，在任何级别的医疗机构分娩的可能性增加了 1.87 倍；aOR=1.97；95%CI：[1.61-2.4]；p<0.001 和 aOR=1.87；95%CI：[1.57-2.23]；p<0.001。
加纳的产前保健利用率和医疗机构分娩利用率显著提高，表明自实施 FMHCP 以来，该政策对加纳产妇保健利用产生了积极影响。
