Impact of free delivery care on health facility delivery and insurance coverage in Ghana's Brong Ahafo Region

PLoS One. 2012;7(11):e49430. doi: 10.1371/journal.pone.0049430. Epub 2012 Nov 16.


Background: Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care--the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana's policies.

Methods: We used time-series methods to assess the impact of Ghana's 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality.

Results: Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes.

Conclusion: Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care / economics*
  • Female
  • Ghana
  • Health Facilities / statistics & numerical data*
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Pregnancy
  • Socioeconomic Factors

Grant support

This study used data collected for the ObaapaVitA and Newhints RCTs. The ObaapaVitA trial was a project funded by the UK Department for International Development (DFID) for the benefit of developing countries. The Newhints trial was funded by the World Health Organization (WHO) and Saving Newborn Lives/Save the Children USA with support from DFID for the surveillance system. The funders of these trials had no role in study design, data collection and analysis, decision to publish, or preparation of this manuscript.