title: Impact of free delivery care on health facility delivery and insurance coverage in Ghana's Brong Ahafo Region.
abstract: BACKGROUND
  Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care--the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana's policies.
  
  
  METHODS
  We used time-series methods to assess the impact of Ghana's 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality.
  
  
  RESULTS
  Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes.
  
  
  CONCLUSIONS
  Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. dzakpasu@lshtm.ac.uk
authors.forename: Susie
authors.initials: S
authors.lastname: Dzakpasu
authors.forename: Seyi
authors.initials: S
authors.lastname: Soremekun
authors.forename: Alexander
authors.initials: A
authors.lastname: Manu
authors.forename: Guus
authors.initials: G
authors.lastname: Ten Asbroek
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah
authors.forename: Lisa
authors.initials: L
authors.lastname: Hurt
authors.forename: Justin
authors.initials: J
authors.lastname: Fenty
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Zelee
authors.initials: Z
authors.lastname: Hill
authors.forename: Oona M R
authors.initials: OM
authors.lastname: Campbell
authors.forename: Betty R
authors.initials: BR
authors.lastname: Kirkwood
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D011247:Pregnancy; D012959:Socioeconomic Factors