Assessing the Impact of Maternal and Child Health and Nutrition Improvement Project (MCHNP) on Service Delivery Outcomes in Ghana

Abstract

Background: Wide range of interventions have been introduced to improve maternal and child health services in Ghana, the most recent intervention introduced is the performance-based financing (PBF) Maternal and Child Health and Nutrition Improvement Project (MCHNP). The implementation of PBF interventions are believed to be based on weak and or very little evidence hence this study seeks to evaluate the impact of the PBF MCHNP on maternal and child health outcomes in Ghana. Methods: A pre-test post-test study design was employed to study women of reproductive age and child within the first 28 days of life in all the 10 regions in Ghana with each region serving as its own control. The study used a retrospective longitudinal data which was obtained from the DHIMS2 database from 2014 to 2018 with the 2014 and 2015 data serving as the controls. Analysis was conducted using interrupted time series controlling for serial autocorrelation and heteroskedascity using the Cumby-Huizinga test for autocorrelation at specified lags employing Stata 15.0 as the statistical tool. Results: The impact of MCHNP on the percentage of women who made 4 ANC visits decreased significantly by 0.011 percent points (p-value <0.01) in the Volta region with the Central, Western, Eastern, Upper East and West region seeing a positive impact however the increases in utilization was not statistically significant. Western, Upper East and Upper West regions recorded a significant increase in the neonatal mortality rate of 0.144, 0.124 and 0.082 per 1,000 LBs (p-value <0.001). The Upper East region of the Savannah belt also recorded and increased neonatal mortality rate of 0.124 per 1,000 LBs (p-value <0.001). The middle belt had no significant change in any of the outlined variables pre and post intervention. Conclusion: The nationwide rollout of the PBF intervention MCHNP was associated with an increased use of maternal health services however these increase were not statistically significant. Maternal and childhood mortalities was a reduction in some regions following MCHNP implementation though the rate of decline were not statistically significant. It is recommended that the design of such useful interventions be tailored to the local drivers of change rather than following the broader context of the design which usually is global.