Influence Of Mutual Health Insurance Scheme On Skilled Attendance At Birth In The Upper West Region Of Ghana

ABSTRACT BACKGROUND: The financial burden of user fees on poor rural households negatively affects the uptake of health services, especially for childbirth. Only 40% of deliveries in Ghana and 27.5% in the UWR took place with the assistance of skilled attendant (GHS 2005; GHS/UWR, 2006). To guarantee financial protection and enhance utilization of healthcare services especially in deprived rural areas, a National‟ Health Insurance Scheme under which the Mutual Health Insurance Scheme operates in every district in Ghana was introduced by the government of Ghana in 2004. OBJECTIVE: to investigate the influence of the MHIS on skilled attendance at birth in the Upper West Region. METHODS: A cross-sectional community-based study was conducted in three districts in the Upper West Region using both qualitative and quantitative approaches. Six FGDs and 20 in-depth interviews were conducted and 400 questionnaires administered to women who had delivered in the years 2006 and 2007 in the districts. Data was collected the demographic, socio-economic and health related characteristics of on the women‟s, knowledge and perceptions on MHIS and skilled care at birth, utilization skilled care at birth, and cultural beliefs and practices that discourage women from delivering under skilled care. Data analysis was carried out using SPSS 16.0 and thematic approach for qualitative data. The association and strength of association between health insurance status and skilled birth was estimated as using the Pearson chi-square test and the Phi coefficient of determination. Other variables that contributed to health facility delivery in the study were also determined. KEY FINDING: The study found a weak but positive linear relationship ( = 0.15) between MHIS cover and health facility delivery at p=0.000. Overall, the study shows 81% of insured women and 63% of uninsured women delivered in a health facility; indicating an 18% increase in utilization of skilled delivery services among mothers who were insured with the MHIS compared to mothers who were uninsured with the scheme. Also, the MHIS cover among women in the study was as high as 86% at their time of delivery. CONCLUSION: the results of this study reveals that the MHIS has significantly improved access to skilled attendance at birth in the Upper West Region and supports the use of health insurance as a health financing tool to provide affordable maternal health services and protect households from out-of-pocket expenditures for women seeking delivery care in health facilities within the context equitable access to health facilities with required enabling environment.