Effects of Delivery Care User Fees Exemption Policy on Utilization and Outcomes of Emergency Obstetric Care Services in Tema General Hospital

Abstract

Background Global challenge and commitment to reduce maternal mortality and morbidity burden in developing countries, particularly in Sub-Saharan Africa required Ghana to improve maternal health and achieve the Millennium Development Goal 5 targets. Ghana in 2003 introduced delivery care user fees exemption policy in four regions to remove financial access barrier to maternal health care services and increase utilization of facility delivery and caesarean section; extended to Tema General Hospital in July 2008. The implementation of delivery fees exemption policy has been extensively evaluated in four regions. This research assessed the effects of delivery care user fees exemption policy on utilization and outcomes of emergency obstetric care services in Tema General Hospital, located in the industrial municipality of Tema District, Greater Accra Region, Ghana. Methods The study design was cross-sectional and descriptive. Obstetric admissions in 2007 and 2009 were used to assess the effects of delivery fees exemption policy on utilization and outcomes of emergency obstetric care services. Non-probability sampling was applied. Quantitative and qualitative data were collected in June 2010 in Tema General Hospital. The data was processed and analyzed manually and with Epi Info. Results The delivery fees exemption policy implemented in Tema General Hospital significantly increased utilization of emergency obstetric care services (p<0.05 at 95% confidence level for deliveries and caesarean sections). The policy had no significant effects on outcomes of emergency obstetric care (p>0.05): maternal mortality (p=0.738) and stillbirths (p=0.217). However, the policy statistically significantly reduced maternal deaths due to abortion complications (Fisher exact 1-tailed p=0.009). The introduction of the policy was not informed by any implementation plan and consequently, increased utilization overwhelmed the unprepared capacity of the hospital, resulting in poor quality of care, low client satisfaction, and reduction in Internally Generated Funds (IGF). Conclusion The delivery care user fees exemption policy introduced in Tema General Hospital significantly increased the utilization of the emergency obstetric care services but did not significantly affect the outcomes. The increased utilization with inadequate supportive policy context and policy measures, and lack of capacity to implement policy effectively resulted to poor quality of care.