Maternal healthcare insurance ownership and service utilisation in Ghana: Analysis of Ghana Demographic and Health Survey

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objectives

Previous studies have attempted to assess the role of health insurance on health care utilization in African settings. However, there is limited evidence on the effects of health insurance on use of maternal health care. In the present study our objective was to measure the prevalence of insurance ownership, types of services covered by the insurance and the association of insurance ownership with the utilization of respective maternal health services in Ghana.

Methods

This study was based on nationally representative Demographic and Health Survey in Ghana (GDHS 2014) encompassing 4,293 mothers aged 15–49 years. Outcome variables were use of early antenatal care (ANC), facility delivery, and postnatal care (PNC) for mothers and children, and the explanatory variables were insurance coverage for these services. Associations were analysed using logistic regression models whilst controlling for potentially confounding variables.

Results

Prevalence of health insurance ownership was 66.8% (95%CI = 64.5–68.9) with significant socioeconomic disparities. The prevalence was higher particularly among women who were urban residents, had higher educational and wealth status. In general, insurance coverage for services such as ANC, childbirth and postnatal care was higher in rural areas, but that of cash benefit was higher in urban areas. Findings of multivariate analysis indicated that women who had their ANC services covered had significantly higher odds of attending at least one and four ANC visits, as well as receiving PNC for child. Insurance coverage for childbirth services showed significant association with the PNC for child, not with choice of health facility delivery. Women who had cash benefit were twice as likely to use early ANC visit (OR = 2.046, p<0.05), facility delivery (OR = 1.449, p<0.05), and PNC for mother (OR = 1.290, p<0.05).

Conclusion

Overall prevalence of health insurance coverage has increased since 2008, with significant disparities across demographic and socioeconomic groups. Insurance ownership for different types of maternal health services showed positive association with service uptake, with exceptions for place of delivery, indicating that insurance coverage alone may not be able to promote facility delivery. More studies are required to measure the progress in maternal healthcare utilisation through the insurance programmes.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: not found

Barriers to the utilization of maternal health care in rural Mali.

Anastasia J. Gage (2007)

This study used data from the 2001 Demographic and Health Survey and multilevel logistic regression models to examine area- and individual-level barriers to the utilization of maternal health services in rural Mali. The analysis highlights a range of area-level influences on the use made of maternal health services. While the dearth of health facilities was a barrier to receipt of prenatal care in the first trimester, transportation barriers were more important for four or more prenatal visits, and distance barriers for delivery assistance by trained medical personnel and institutional delivery. Women's odds of utilizing maternal health services were strongly influenced by the practices of others in their areas of residence and by living in close proximity to people with secondary or higher education. Household poverty and personal problems were negatively related to all outcomes considered. The results highlight the importance of antenatal care and counseling about pregnancy complications for increasing the likelihood of appropriate delivery care, particularly among women living 15-29 km from a health facility. Area-level factors explained a greater proportion of the variation in delivery care than in prenatal care However, significant area variation in the utilization of maternal health services remained unexplained.

0 comments Cited 123 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition.

Robert E Black, Carol Levin, Neff Walker … (2016)

As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention). Scaling up all interventions in these packages from coverage in 2015 to hypothetically immediately achieve 90% coverage would avert 149 000 maternal deaths, 849 000 stillbirths, 1 498 000 neonatal deaths, and 1 515 000 additional child deaths. In alternative calculations that consider only the effects of reducing the number of pregnancies by provision of contraceptive services as part of a Reproductive Health package, meeting 90% of the unmet need for contraception would reduce global births by almost 28 million and consequently avert deaths that could have occurred at 2015 rates of fertility and mortality. Thus, 67 000 maternal deaths, 440 000 neonatal deaths, 473 000 child deaths, and 564 000 stillbirths could be averted from avoided pregnancies. Particularly effective interventions in the Maternal and Newborn Health and Child Health packages would be management of labour and delivery, care of preterm births, and treatment of serious infectious diseases and acute malnutrition. Nearly all of these essential interventions can be delivered by health workers in the community or in primary health centres, which can increase population access to needed services. The annual incremental cost of immediately scaling up these essential interventions would be US$6·2 billion in low-income countries, $12·4 billion in lower-middle-income countries, and $8·0 billion in upper-middle-income countries. With the additional funding, greater focus on high-effect integrated interventions and innovations in service delivery, such as task shifting to other groups of health workers and supply and demand incentives, can help rectify major gaps in accessibility and quality of care. In recent decades, reduction of avoidable maternal and child deaths has been a global priority. With continued priority and expansion of essential reproductive, maternal, newborn, and child health interventions to high coverage, equity, and quality, as well as interventions to address underlying problems such as women's low status in society and violence against women, these deaths and substantial morbidity can be largely eliminated in another generation.

0 comments Cited 105 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Success factors for reducing maternal and child mortality

Shyama Kuruvilla, Julian Schweitzer, David Bishai … (2014)

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond.

0 comments Cited 103 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Sanni Yaya:

ORCID: http://orcid.org/0000-0002-4876-6043

Role: MethodologyRole: Writing – original draftRole: Writing – review & editing

Feng Da: Role: Project administrationRole: SoftwareRole: Supervision

Ruoxi Wang: Role: ResourcesRole: SoftwareRole: SupervisionRole: Writing – review & editing

Shangfeng Tang: Role: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draft

Bishwajit Ghose:

ORCID: http://orcid.org/0000-0003-4461-3821

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Uwe Schneider: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 25 April 2019

Publication date Collection: 2019

Volume: 14

Issue: 4

Electronic Location Identifier: e0214841

Affiliations

[1 ] School of International Development and Global Studies, University of Ottawa, Ottawa, Canada

[2 ] School of Pharmacy, Tongji Medical College, Wuhan, China

[3 ] School of Medicine and Health Management, Tongji Medical College, Wuhan, China

[4 ] Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh

University Hospital of Jena, GERMANY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: sftang2018@ 123456hust.edu.cn (ST); brammaputram@ 123456gmail.com (GB)

Author information

Sanni Yaya http://orcid.org/0000-0002-4876-6043

Bishwajit Ghose http://orcid.org/0000-0003-4461-3821

Article

Publisher ID: PONE-D-18-18328

DOI: 10.1371/journal.pone.0214841

PMC ID: 6483336

PubMed ID: 31022201

SO-VID: 97a9c0e9-e111-488b-826a-56de2e6f4022

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 19 June 2018

Date accepted : 22 March 2019

Page count

Figures: 1, Tables: 4, Pages: 13

Funding

This study was partially supported by “Fundamental research funds for central universities in China.” The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability The data underlying the study belongs to a third party. The dataset can be obtained from: https://www.dhsprogram.com/data/available-datasets.cfm. The authors did not have any special access privileges that others would not have. Anyone can access the data after creating an account and sending a research proposal through the website.

Maternal healthcare insurance ownership and service utilisation in Ghana: Analysis of Ghana Demographic and Health Survey

Read this article at

Abstract

Objectives

Methods

Results

Conclusion

Related collections

PLOS Global Public Health

Most cited references 25

Barriers to the utilization of maternal health care in rural Mali.

Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition.

Success factors for reducing maternal and child mortality

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 156

Cited by 31

Most referenced authors 1,390