Burden of out-of-pocket payment for maternal healthcare and its catastrophic effects in the era of free maternal and child health policy in Ghana

Ghana introduced a free maternal healthcare policy within its national health insurance program in 2008. Despite this, there are reports of significant out-of-pocket (OOP) payments for maternal healthcare in Ghana. This study examines OOP payments for maternal healthcare services and their catastrophic effects, including the correlates of catastrophic OOP payments. Cross-sectional quantitative data were collected from 414 mothers through health facility exit interviews in two regions of Ghana. Catastrophic OOP payments were computed by expressing total health expenditure as a percentage of household total expenditure and non-food expenditure at various thresholds (5 %, 10 %, 20 % and 25 %). The correlates of catastrophic OOP payments were assessed using logistic regression models. The median OOP payments for maternal healthcare was GH₵866. 5 (US109. 3). The median non-medical OOP cost (GH₵479US 59. 9) was higher than the median medical OOP cost (GH₵296. 5US 37. 1). The median OOP cost was higher for delivery (GH₵454US56. 8) compared to ANC (GH₵356. 5US44. 5) and PNC (GH₵21. 5US2. 6). Non-medical supplies comprise 58 % of the total OOP payments. About 73 % and 90 % of respondents spent more than 5 % of their annual household total and non-food expenditure on maternal healthcare, respectively. Rural areas and care at private facilities were significantly associated (AORs 1; p-values<0. 05) with a higher probability of incurring catastrophic OOP payments. OOP payments for maternal care are still prevalent in Ghana. We call for a reform of Ghana's free maternal healthcare policy to include non-medical supplies within its benefit package.