PROMOTING FREE MATERNAL HEALTHCARE IN GHANA: A COMPARATIVE STUDY ON ACCESSIBILITY OF RURAL AND URBAN WOMEN IN THE SUNYANI MUNICIPALITY OF GHANA

Abstract

Access and utilization of basic health services remain major health challenges especially in developing countries including Ghana. The inadequacy and/or lack of access to maternal health services have contributed significantly to the high maternal mortality rates especially in Ghana. Hence, the Free Maternal Healthcare (FMHC) Policy was introduced to help address the challenge. The policy was introduced as a way of ensuring that those who could not afford the cost of maternal health care would be covered. As a national policy it is supposed to care for all pregnant women by bridging the gaps in access. However, in practice there are various existing gaps that have the potential of affecting the implementation of the policy. This study employed a descriptive survey to understand the place of inequality in accessibility in the promotion of free maternal healthcare services between women of rural (Nkrankrom and Nwawasua) and urban (Abesim and Sunyani Township) communities in the Sunyani Municipality of the Brong Ahafo Region of Ghana. Two rural and urban communities each from the Sunyani Municipality were sampled using purposeful, stratified and random sampling techniques for the study. A total of 270 respondents, comprising 250 women from the four communities and 20 healthcare workers, participated in the study. Both qualitative and quantitative data were collected using structured interviews, key informant interviews and desk review. Data was processed with the aid of SPSS and MS Excel computer software. The study results indicated that majority of maternal healthcare services offered were under the NHIS scheme and include antenatal clinic services, post natal clinic services, delivery (normal and caesarean sessions). However, the results showed that some services namely scan and laboratory services, birth complications, incubator services and other conditions requiring major surgeries were exempted under the scheme. Again, the results showed that maternal healthcare services offered in urban communities included antenatal clinics, post-natal clinics, delivery services, general gynecology services and consultation, laboratory and scan services. However, the CHPS compounds which were predominant in rural communities did not offer maternal healthcare services, hence the women's inability to access the free services within their communities. The results further proved that respondents living in locations with more healthcare facilities had shorter distances to travel to such facilities and vice versa. Respondents from the urban communities travelled for between zero and five kilometres to have access to healthcare whilst majority of respondents from rural communities to travel between six to ten kilometers and more to the nearest health facility to access maternal healthcare. It was also found that the utilization of maternal healthcare services in urban communities was higher relative to same in rural communities due to the availability and level of accessibility to these facilities and/or services resulting in the use of services of TBAs. The frequency of use of maternal healthcare services especially antenatal clinical attendance was low among rural communities compared to urban communities. Maternal healthcare services providers or professionals were mainly found in the hospitals, clinics, maternity homes and health centers in the urban communities with the limited numbers (mainly community health nurses) visiting rural communities. For the rural communities, majority of the CHPS compounds had no skilled professionals to run the facility. Generally, the study showed that majority of the respondents were satisfied with the quality of care under the FHMC policy. The study therefore concluded that there was disparity in the level of accessibility between rural and urban women to maternal healthcare services in the Sunyani Municipality and that although the FHMC was free and intended to equalize access, in practice existing inequalities between rural and urban health services were compromising on the level ofaccess to the disadvantage of rural women. The access to maternal healthcare services in the rural communities was constrained by factors related but not limited to proximity to healthcare facilities, means and cost of transportation, availability and choice of facilities and/or services, socio-cultural and economic barriers. The study recommends, among other things, that healthcare facilities should be provided for the deprived rural communities and staff with trained medical personnel who can provide the various services provided under the free maternal health scheme.