| 1. Peer Reviewed Title: The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Author: Witter S; Arhinful DK; Kusi A; Zakariah-Akoto S Source: Reproductive Health Matters. 2007 Sep;15(30):61-71. Abstract: In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of countries are experimenting with different approaches to tackling financial barriers to maternal health care. This paper describes an innovative scheme introduced in Ghana in 2003 to exempt all pregnant women from payments for delivery, in which public, mission and private providers could claim back lost user fee revenues, according to an agreed tariff. The paper presents part of the findings of an evaluation of the policy based on interviews with 65 key informants in the health system at national, regional, district and facility level, including policymakers, managers and providers. The exemption mechanism was well accepted and appropriate, but there were important problems with disbursing and sustaining the funding, and with budgeting and management. Staff workloads increased as more women attended, and levels of compensation for services and staff were important to the scheme's acceptance. At the end of 2005, a national health insurance scheme, intended to include full maternal health care cover, was starting up in Ghana, and it was not yet clear how the exemptions scheme would fit into it. (author's) Language: English Keywords: GHANA | PROGRESS REPORT | EVALUATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | DELIVERY OF HEALTH CARE | FEES | GOVERNMENT FINANCING | HEALTH POLICY | PROGRAM ACCESSIBILITY | MATERNAL HEALTH SERVICES | PROGRAM SUSTAINABILITY | GOVERNMENT PROGRAMS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health | Financial Activities | Policy | Political Factors | Sociocultural Factors | Program Evaluation | Programs | Organization and Administration | Maternal-Child Health Services | Primary Health Care | Health Services Document Number: 321360 |
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