Abstract
Beginning in the late 1960's, and accelerating after 1985, a system known as "Cash and Carry" required the people of Ghana to pay for health services out-of-pocket before receiving them. In 2003, Ghana enacted a National Health Insurance Scheme (NHIS) (fully implemented by 2005) that allowed pregnant women to access antenatal care and hospital delivery services for low annual premiums tied to income. The objective of this study was to compare trends in low birth weight (LBW) among infants born under the NHIS with infants born during the Cash and Carry system when patients paid out-of-pocket for maternal and child health services. Sampled birth records abstracted from birth folders at the Tamale Teaching Hospital (TTH) were examined. Chi-squared tests were performed to determine differences in the prevalence of LBW. A p-value of ≤ 0.05 was considered statistically significant. Analyses were conducted for selected variables in each year from 2000 to 2003 (Cash and Carry) and 2008 to 2011(NHIS). Higher birth weights were not observed for deliveries under NHIS compared to those under Cash and Carry. More than one-third of infants in both eras were born to first-time mothers, and they had a significantly higher prevalence of LBW compared to infants born to multiparous mothers. Understanding the factors that affect the prevalence of LBW is crucial to public health policy makers in Ghana. LBW is a powerful predictor of infant survival, and therefore, an important factor in determining the country's progress toward meeting the United Nations Millennium Development Goal of reducing under-five child mortality rates (MDG4) by the end of 2015.
Highlights
Beginning in the late 1960’s, and accelerating after 1985, a system known as “Cash and Carry” required the people of Ghana to pay for health services out-of-pocket before receiving them
This study examined trends in low birth weight (LBW) among infants born during the Cash and Carry period compared to infants born under the National Health Insurance Scheme (NHIS)
The current study showed that more than onethird of infants were born to first-time mothers, who experienced significantly higher prevalence of LBW in both the Cash and Carry and NHIS periods
Summary
Beginning in the late 1960’s, and accelerating after 1985, a system known as “Cash and Carry” required the people of Ghana to pay for health services out-of-pocket before receiving them. In 2003, Ghana enacted a National Health Insurance Scheme (NHIS) (fully implemented by 2005) that allowed pregnant women to access antenatal care and hospital delivery services for low annual premiums tied to income. When Ghana attained independence under Kwame Nkrumah in 1957, a national health service (NHS) similar to that of Britain’s was established to extend free care to the entire population at government health facilities. The NHS system remained in place until shortly after 1966, when the Nkrumah government was overthrown in a military coup.[2,3] A system for health service fees was introduced through the Hospital Fees Decree in 1969, later amended by the Hospital Fees Act in 1971, but the fees were never fully implemented. Fees were eventually imposed under the Hospital Fees Regulation of 1985, when economic growth slowed and rising inflation crippled Ghana’s economy and forced the country to turn to the International Monetary Fund and the World Bank for financial assistance.[4,5]
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