Association Between National Health Insurance Scheme And Birth Weight Outcomes In Northern Ghana

Abstract

The health of poor women and their infant children remains a serious problem in developing countries. Many of these health problems manifest during pregnancy and delivery, which too often culminates in infant and maternal deaths, and birth weights so low that the child's health is affected later in life. Access to maternal and child health services and a way to pay for those services is considered a sine qua non to address infant and maternal mortality and low birth weight (LBW, defined as under 2,500 grams or 5.5 pounds), with its attendant later-in-life health effects on children. In 2003, Ghana introduced a national health insurance scheme (NHIS) that eliminates financial barriers to maternal health services. The NHIS replaced a health user fee system (known as "cash & carry") that had limited access to skilled care for maternal and child services. This dissertation research explored the relationship between the access to care provided under NHIS and LBW in economically deprived northern Ghana. The relationship between NHIS and LBW in the region has been largely ignored in literature on the NHIS. This study determined the differences in LBW among infants delivered under NHIS compared to infants delivered under the cash and carry. Sample data were abstracted from delivery records at Northern Ghana's Tamale Teaching Hospital of births during the cash and carry (as comparison) period in 2000 and births in 2010 after the NHIS (as experiment) was fully implemented nationwide. Chi-Square tests and logistic regression were used to examine the associations between birth weights and insurance status. Of the 1,433 births examined, 1,355 (94.6%) were live births, and 78 (5.4%) were still-births. The prevalence of LBW among cash and carry infants is 23.2%. This is significantly higher than among NHIS infants - 16.8%. The difference represents a 27% reduction in LBW (p=0.008). In the multiple regression model, infants born under the NHIS are twice more likely to weigh 2,500 grams or higher (OR = 2.06; 95% CI = 1.38, 3.06), a birth weight standard that the World Health Organization considers normal. By implication, the NHIS afforded mothers in Northern Ghana the opportunity to deliver their babies at a hospital where prenatal care before delivery, access to skilled care at delivery, and weight of infants at birth were available. Hospital delivery would be impossible for the majority of women in Northern Ghana who were too poor to pay for the cost of hospital-based deliveries.