Browsing by Person "Armar-Klemesu, Margaret"

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National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal
(Antwerp: ITG Press, 2008) Witter, Sophie; Armar-Klemesu, Margaret; Dieng, Thierno
Continuing high maternal mortality ratios, especially in Africa, and high discrepancies between richer and poorer households in relation to access to maternal health care and maternal health status have focussed attention on the importance of reducing financial barriers to skilled care. This article compares the findings of two studies on national policies exempting women from user fees for deliveries, conducted in Ghana in 2005-6 and in Senegal in 2006-7. The evaluations used a combination of research methods, including key informant interviews, household surveys, financial flows tracking, health worker incentive surveys, confidential enquiry, clinical case note record extraction, community level interviews and focus group discussions. The detailed findings from each evaluation are presented, followed by the broad lessons learnt from these similar (but not identical) policies. The policies shared goals, and both were implemented in poorer regions initially but then scaled up, using national resources. They demonstrate the potential of fee exemption policies to increase utilisation. The cost per additional assisted delivery was $62 (average) in Ghana and $21 (normal delivery) and $467 (caesarean section) in Senegal. There was also some evidence of reductions in inequalities of access.
Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana
(2009-01-13) Witter, Sophie; Adjei, Sam; Armar-Klemesu, Margaret; Graham, Wendy
Background: There is a growing movement, globally and in the Africa region, to reduce financial barriers to health care generally, but with particular emphasis on high priority services and vulnerable groups. Objective: This article reports on the experience of implementing a national policy to exempt women from paying for delivery care in public, mission and private health facilities in Ghana. Design: Using data from a complex evaluation which was carried out in 2005-2006, lessons are drawn which can inform other countries starting or planning to implement similar service-based exemption policies. Results: On the positive side, the experience of Ghana suggests that delivery exemptions can be effective and cost-effective, and that despite being universal in application, they can benefit the poor. However, certain 'negative' lessons are also drawn from the Ghana case study, particularly on the need for adequate funding, and for strong institutional ownership. It is also important to monitor the financial transfers which reach households, to ensure that providers are passing on benefits in full, while being adequately reimbursed themselves for their loss of revenue. Careful consideration should also be given to staff motivation and the role of different providers, as well as quality of care constraints, when designing the exemptions policy. All of this should be supported by a proactive approach to monitoring and evaluation. Conclusion: The recent movement towards making delivery care free to all women is a bold and timely action which is supported by evidence from within and beyond Ghana. However, the potential for this to translate into reduced mortality for mothers and babies fundamentally depends on the effectiveness of its implementation.