ArticleHealth research policy and systems2024
Why "free maternal healthcare" is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power.
Article in Health research policy and systems, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Socio-medical consequences of living with obstetric fistula: a phenomenological study of the lived experiences of women in the Tamale Metropolis, Ghana.BMC pregnancy and childbirth · 2026Article
- Women's decision-making autonomy and early antenatal care initiation in Ghana: a propensity score-matched analysis.BMC women's health · 2026Article
- Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.Health policy and planning · 2026Article
- Article
- Association between out-of-pocket health expenditures and low birth weight in Eastern Ethiopia: a generalized structural equation modeling (GSEM).BMC public health · 2025Article
- Neonatal Jaundice Treatment Versus Recommendations: The Challenge of Treatment Without Rapid Diagnostic Capability.International journal of environmental research and public health · 2025Article
- Cost-Effectiveness of Aerial Logistics for Maternal and Newborn Health: A Simulation-Based Analysis Grounded in Real-World Evidence from the Ashanti Region in Ghana.Journal of health economics and outcomes research · 2025Article
- Healthcare needs and treatment-seeking patterns of women living with obstetric fistula: a qualitative study in the Tamale Metropolis, Ghana.BMJ public health · 2025Article
- Why "free maternal healthcare" is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power.Health research policy and systems · 2024Article
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Authors and funding
6 authors.
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Abstract
backgroundGhana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana's free maternal healthcare policy.
methodsCross-sectional qualitative data were collected through interviews with a purposive sample of 14 mothers and 8 healthcare providers/administrators in two regions of Ghana between May and September 2022. All interviews were audio-recorded, transcribed and imported into the NVivo 14.0 software for analysis. An iteratively developed codebook guided the coding process. Our thematic data analysis followed the Attride-Sterling framework for network analysis, identifying basic, organising themes and global themes.
resultsWe found that health systems and demand-side factors are responsible for the persistence of OOP payments despite the existence of the free maternal healthcare policy in Ghana. Reasons for these payments arose from health systems factors, particularly, NHIS structural issues - delayed and insufficient reimbursements, inadequate NHIS benefit coverage, stockouts and supply chain challenges and demand-side factors - mothers' lack of education about the NHIS benefit package, and passing of cost onto patients. Due to structural and system level challenges, healthcare providers, exercising their street-level bureaucratic power, have partly repackaged the policy, enabling the persistence of out-of-pocket payments for maternal healthcare.
conclusionsUrgent measures are required to address the structural and administrative issues confronting Ghana's free maternal health policy; otherwise, Ghana may not achieve the sustainable development goals targets on maternal and child health.
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