Impact of Free Maternal Care Policy on Maternal and Child Health Indicators in Ghana

Abstract

Background: Maternal and child mortality remain major global public health challenges. Majority of the world’s maternal mortality occur in low–income countries including Ghana, where financial barriers make maternal healthcare inaccessible to many women
during obstetric emergencies, resulting in avoidable maternal deaths. Ghana implemented a free maternal care policy nation-wide in 2008 .to provide pregnant women antenatal, delivery and postnatal care in public, and accredited private healthcare facilities. This work assesses the impact of the policy on selected Maternal and Child Health (MCH) indicators in Ghana.
Methods: Literature on financial barriers to maternal healthcare in Low Income Countries (LICs) was reviewed. WHO databases were searched for MCH indicators for Ghana from 2000-2011, aggregated and trends analysed. Additional data was obtained from Maamobi Polyclinic, Koforidua Regional Hospital (KRH), and the Korle Bu Teaching Hospitals (KBTH). These were statistically analysed for trends to assess the policy’s impact on these indicators.
Results: Over four years of implementation, average antenatal coverage increased by 2%, skilled birth attendance 11%; contraceptive prevalence unchanged and unmet need for contraception rose marginally. Under-5 mortality declined by 22%. KBTH recorded increased antenatal (ANC) attendance and decreased annual deliveries that were non-significant. Maternal Mortality Rate (MMR) increased by 89/100,000LB; Caesarean section (C/S) rate rose by 5.5%, fresh still birth (FSB) rate increased and Neonatal intensive care
unit (NICU) admissions surged 21%. KRH recorded significant increases in deliveries by 2114; C/S rate by 3% while MMR reduced by 0.56% (562/100,000LB). However, the FSB proportion increased by 13%, ANC attendance reduced by 567, annual deliveries rose by
300, C/S rate and FSB increased by 3% and 11% respectively per year at the Maamobi Polyclinic.
Conclusion: Encouraging trends were observed in the MCH indicators attributable to the policy. Increasing FSB rates indicate inadequate care quality especially intra-partum monitoring possibly due to over-stretched staff and facilities from rising patient loads.