John Kanyiri Yambah1,2, Kofi Akohene Mensah3, Naasegnibe Kuunibe4, Kindness Laar3, Roger Ayimbillah Atinga5, Millicent Ofori Boateng6, Daniel Opoku3, Wilm Quentin7. 1. University Health Services, University of Education, Winneba, Ghana. yambahjohn@yahoo.com. 2. Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. yambahjohn@yahoo.com. 3. Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 4. Department of Economics, Faculty of Social Science and Arts, SD-Dombo University of Business and Integrated Development Studies, Wa, Ghana. 5. Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana. 6. Department of Community Health, Ensign Global College, Kpong, Ghana. 7. Department of Health Care Management, Technische Universitat Berlin, Berlin, Germany.
Abstract
BACKGROUND: Payment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana's capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap. METHODS: We used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4+ (visits of pregnant women making at least the fourth antenatal care attendance per month), HB36 (number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation) and vaginal delivery in capitated facilities-CHPS (Community-based Health Planning and Services) facilities and hospitals. RESULTS: The results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+ in hospitals (coefficient 70.99 p < 0. 001) but no effect in CHPS facilities. Also, the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36; a statistically significant decline was observed in CHPS (coefficient - 7.01, p < 0.05) while that of hospitals showed a statistically significant trend increase (coefficient 32.87, p < 0.001). Finally, the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals. CONCLUSIONS: The capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals; repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities. Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.
BACKGROUND: Payment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana's capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap. METHODS: We used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4+ (visits of pregnant women making at least the fourth antenatal care attendance per month), HB36 (number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation) and vaginal delivery in capitated facilities-CHPS (Community-based Health Planning and Services) facilities and hospitals. RESULTS: The results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+ in hospitals (coefficient 70.99 p < 0. 001) but no effect in CHPS facilities. Also, the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36; a statistically significant decline was observed in CHPS (coefficient - 7.01, p < 0.05) while that of hospitals showed a statistically significant trend increase (coefficient 32.87, p < 0.001). Finally, the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals. CONCLUSIONS: The capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals; repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities. Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.
Authors: Racquel Jandoc; Andrea M Burden; Muhammad Mamdani; Linda E Lévesque; Suzanne M Cadarette Journal: J Clin Epidemiol Date: 2015-03-11 Impact factor: 6.437
Authors: Christel E van Dijk; Bernard van den Berg; Robert A Verheij; Peter Spreeuwenberg; Peter P Groenewegen; Dinny H de Bakker Journal: Health Econ Date: 2012-02-20 Impact factor: 3.046