National fee exemption schemes for deliveries: comparing the recent experiences of Ghana and Senegal
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Date
2008Author
Witter, Sophie
Armar-Klemesu, Margaret
Dieng, Thierno
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Witter, S., Armar-Klemesu, M. & Dieng, T. (2008) National fee exemption schemes for deliveries:
comparing the recent experiences of Ghana and
Senegal, Studies in Health Services Organisation and Policy series, vol. 24, pp. 167-198.
Abstract
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.