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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 15, 2007 - Issue 30: Maternal mortality and morbidity
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Original Articles

The Experience of Ghana in Implementing a User Fee Exemption Policy to Provide Free Delivery Care

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Pages 61-71 | Published online: 13 Oct 2007

Keep up to date with the latest research on this topic with citation updates for this article.

Read on this site (6)

Christmal Dela Christmals & Kizito Aidam. (2020) Implementation of the National Health Insurance Scheme (NHIS) in Ghana: Lessons for South Africa and Low- and Middle-Income Countries. Risk Management and Healthcare Policy 13, pages 1879-1904.
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Gbenga A. Kayode, Diederick E. Grobbee, Augustina Koduah, Mary Amoakoh-Coleman, Irene A. Agyepong, Evelyn Ansah, Han van Dijk & Kerstin Klipstein-Grobusch. (2016) Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs. Global Health Action 9:1.
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Gita Sen & Veloshnee Govender. (2015) Sexual and reproductive health and rights in changing health systems. Global Public Health 10:2, pages 228-242.
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Ayako Honda, Pierana Gabriel Randaoharison & Mitsuaki Matsui. (2011) Affordability of emergency obstetric and neonatal care at public hospitals in Madagascar. Reproductive Health Matters 19:37, pages 10-20.
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Fyson Kasenga, Peter Byass, Maria Emmelin & Anna-Karin Hurtig. (2009) The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience. Global Health Action 2:1.
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Articles from other publishers (119)

Anthony Idowu Ajayi, Bright Opoku Ahinkorah & Abdul-Aziz Seidu. (2023) “I don't like to be seen by a male provider”: health workers’ strike, economic, and sociocultural reasons for home birth in settings with free maternal healthcare in Nigeria. International Health 15:4, pages 435-444.
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Juliet Abredu, Boo Alipitio, Catherine K. Dwumfour, Sophie Witter & Veronica Millicent Dzomeku. (2023) Factors influencing the free maternal health care policy under the national health insurance scheme’s provision for skilled delivery services in Ghana: a narrative literature review. BMC Pregnancy and Childbirth 23:1.
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Boniface Oyugi, Sally Kendall, Stephen Peckham & Edwine Barasa. (2023) Out-of-pocket payments during childbirth in Kenya under the free maternity services: Perspectives of mothers, healthcare workers and county officials. Wellcome Open Research 8, pages 4.
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Lalique Browne, Sarah Cooper, Cheick Tiendrebeogo, Frank Bicaba, Alice Bila, Abel Bicaba & Thomas Druetz. (2022) Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina FasoUne évaluation de processus de la nouvelle politique d’exemption du paiement direct pour la planification familiale au Burkina Faso. Reproductive Health 19:1.
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Luchuo Engelbert Bain, Richard Gyan Aboagye, Robert Kokou Dowou, Eugene Justine Kongnyuy, Peter Memiah & Hubert Amu. (2022) Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data. BMC Public Health 22:1.
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Veronica Millicent Dzomeku, Precious Adade Duodu, Joshua Okyere, Livingstone Aduse-Poku, Nutifafa Eugene Yaw Dey, Adwoa Bemah Boamah Mensah, Emmanuel Kweku Nakua, Pascal Agbadi & Jerry John Nutor. (2021) Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys. BMC Pregnancy and Childbirth 21:1.
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Monica Ansu-Mensah, Frederick Inkum Danquah, Vitalis Bawontuo, Peter Ansu-Mensah, Tahiru Mohammed, Roseline H. Udoh & Desmond Kuupiel. (2021) Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions. BMC Pregnancy and Childbirth 21:1.
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Maxwell T Kumbeni & Paschal A Apanga. (2021) Institutional delivery and associated factors among women in Ghana: findings from a 2017–2018 multiple indicator cluster survey. International Health 13:6, pages 520-526.
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Stacey Orangi, Angela Kairu, Joanne Ondera, Boniface Mbuthia, Augustina Koduah, Boniface Oyugi, Nirmala Ravishankar & Edwine Barasa. (2021) Examining the implementation of the Linda Mama free maternity program in Kenya. The International Journal of Health Planning and Management 36:6, pages 2277-2296.
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Matilda Aberese-Ako, Pascal Magnussen, Gifty D. Ampofo, Margaret Gyapong, Evelyn Ansah & Harry Tagbor. (2021) An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context. PLOS ONE 16:10, pages e0257666.
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Emmanuel Quarshie, Priscilla Davies & Pearl Otoo. (2021) Setting Mental Health Priorities in Ghana: A 15-Year Contextual Analysis of the Presidential State of the Nation Address. Challenges 12:2, pages 22.
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Gordon Dugle, Bernard Afiik Akanpabadai Akanbang & Gilbert Abotisem Abiiro. (2021) Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective. Women and Birth 34:2, pages 187-195.
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Boniface Oyugi, Sally Kendall & Stephen Peckham. (2021) Effects of free maternal policies on quality and cost of care and outcomes: an integrative review. Primary Health Care Research & Development 22.
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Ayalneh Demissie, Alemayehu Worku & Yemane Berhane. (2020) Effect of Implementing a Free Delivery Service Policy on Women’s Utilization of Facility-Based Delivery in Central Ethiopia: An Interrupted Time Series Analysis. Journal of Pregnancy 2020, pages 1-7.
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John Amissah, Emmanuel Kwaku Nakua, Eric Badu, Alexander Baba Amissah & Leticia Lariba. (2020) In search of universal health coverage: the hidden cost of family planning to women in Ghana. BMC Research Notes 13:1.
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Oluwasegun Jko Ogundele, Milena Pavlova & Wim Groot. (2020) Inequalities in reproductive health care use in five West-African countries: A decomposition analysis of the wealth-based gaps. International Journal for Equity in Health 19:1.
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Matilda Aberese-Ako, Pascal Magnussen, Margaret Gyapong, Gifty D. Ampofo & Harry Tagbor. (2020) Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions. Malaria Journal 19:1.
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Monica Ansu-Mensah, Frederick I. Danquah, Vitalis Bawontuo, Peter Ansu-Mensah & Desmond Kuupiel. (2020) Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review. BMC Health Services Research 20:1.
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Sawa Omori & Marah Alagon. (2020) Polycentric governance and the provision of free healthcare services at public hospitals in the Philippines. Health Policy and Planning.
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Mahama Saaka & Jones Akuamoah-Boateng. (2020) Prevalence and Determinants of Rural-Urban Utilization of Skilled Delivery Services in Northern Ghana. Scientifica 2020, pages 1-13.
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Duah Dwomoh, Kofi Agyabeng, Kwame Agbeshie, Gabriel Incoom, Priscilla Nortey, Alfred Yawson & Samuel Bosomprah. (2020) Impact evaluation of the free maternal healthcare policy on the risk of neonatal and infant deaths in four sub-Saharan African countries: a quasi-experimental design with propensity score Kernel matching and difference in differences analysis. BMJ Open 10:5, pages e033356.
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Michael Boah, Timothy Adampah, Baiming Jin, Siyuan Wan, Abraham Bangamsi Mahama, Dalia Hyzam & Caselia Akiti. (2020) “I couldn’t buy the items so I didn’t go to deliver at the health facility” Home delivery among rural women in northern Ghana: A mixed-method analysis. PLOS ONE 15:3, pages e0230341.
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Boukary Sana, Ahmed Kaboré, Hervé Hien, Brice Evance Zoungrana & Nicolas Meda. (2019) Etude de l'utilisation des médicaments chez les enfants dans un contexte de gratuité des soins. Pan African Medical Journal 34.
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Ivlabèhiré Bertrand Meda, Adama Baguiya, Valéry Ridde, Henri Gautier Ouédraogo, Alexandre Dumont & Seni Kouanda. (2019) Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey. Health Economics Review 9:1.
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Patricia E. Bailey, John Koku Awoonor-Williams, Victoria Lebrun, Emily Keyes, Mario Chen, Patrick Aboagye & Kavita Singh. (2019) Referral patterns through the lens of health facility readiness to manage obstetric complications: national facility-based results from Ghana. Reproductive Health 16:1.
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Emmanuel Dankwah, Shelley Kirychuk, Wu Zeng, Cindy Feng & Marwa Farag. (2019) Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data. International Journal for Equity in Health 18:1.
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John Kuumuori Ganle, Mathew Loyarl Kombet & Leonard Baatiema. (2019) Factors influencing the use of supervised delivery services in Garu-Tempane District, Ghana. BMC Pregnancy and Childbirth 19:1.
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Marta Schaaf & Stephanie M Topp. (2019) A critical interpretive synthesis of informal payments in maternal health care. Health Policy and Planning 34:3, pages 216-229.
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John Kuumuori Ganle, Musah Salifu Mahama, Ernest Maya, Abubakar Manu, Kwasi Torpey & Richard Adanu. (2019) Understanding factors influencing home delivery in the context of user‐fee abolition in Northern Ghana: Evidence from 2014 DHS. The International Journal of Health Planning and Management 34:2, pages 727-743.
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John Kuumuori Ganle & Ebenezer Krampah. 2019. Selected Topics in Midwifery Care. Selected Topics in Midwifery Care.
Sarah Jane Steele, Hartini Sugianto, Quentin Baglione, Sandra Sedlimaier, Aline Aurore Niyibizi, Kristal Duncan, Julia Hill, Jesper Brix, Mit Philips, Gilles Van Cutsem & Amir Shroufi. (2018) Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho. Tropical Medicine & International Health 24:1, pages 2-10.
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Gordon Abekah-Nkrumah, Sombié Issiaka, Lokossou Virgil & Johnson Ermel. (2018) A review of the process of knowledge transfer and use of evidence in reproductive and child health in Ghana. Health Research Policy and Systems 16:1.
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Gifty Dufie Ampofo, Harry Tagbor & Imelda Bates. (2018) Effectiveness of pregnant women’s active participation in their antenatal care for the control of malaria and anaemia in pregnancy in Ghana: a cluster randomized controlled trial. Malaria Journal 17:1.
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Patricia Anafi, Wisdom K. Mprah, Allen M. Jackson, Janelle J. Jacobson, Christopher M. Torres, Brent M. Crow & Kathleen M. O’Rourke. (2018) Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra. International Quarterly of Community Health Education 38:4, pages 259-267.
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Lisa M. Calhoun, Ilene S. Speizer, David Guilkey & Elizabeth Bukusi. (2017) The Effect of the Removal of User Fees for Delivery at Public Health Facilities on Institutional Delivery in Urban Kenya. Maternal and Child Health Journal 22:3, pages 409-418.
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Joshua Amo-Adjei, Kofi Aduo-Adjei, Christiana Opoku-Nyamah & Chimaroake Izugbara. (2018) Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs). PLOS ONE 13:2, pages e0192513.
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Oumar Mallé Samb & Valery Ridde. (2018) The impact of free healthcare on women's capability: A qualitative study in rural Burkina Faso. Social Science & Medicine 197, pages 9-16.
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Martin Amogre Ayanore, Milena Pavlova, Regien Biesma & Wim Groot. (2017) Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors. The International Journal of Health Planning and Management 33:1.
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Eric Tama, Sassy Molyneux, Evelyn Waweru, Benjamin Tsofa, Jane Chuma & Edwine Barasa. (2017) Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation. International Journal of Health Policy and Management 7:7, pages 603-613.
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Eric Adua, Kwasi Frimpong, Xia Li & Wei Wang. (2017) Emerging issues in public health: a perspective on Ghana’s healthcare expenditure, policies and outcomes. EPMA Journal 8:3, pages 197-206.
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Thomas Druetz, Abel Bicaba, Telesphore Some, Seni Kouanda, Antarou Ly & Slim Haddad. (2017) Effect of interrupting free healthcare for children: Drawing lessons at the critical moment of national scale-up in Burkina Faso. Social Science & Medicine 185, pages 46-53.
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Chitalu Miriam Chama-Chiliba & Steven Fredric Koch. (2016) An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia. BMC Research Notes 9:1.
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Martin Amogre Ayanore, Milena Pavlova & Wim Groot. (2016) Focused maternity care in Ghana: results of a cluster analysis. BMC Health Services Research 16:1.
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Eric Osei, Isaac Agbemefle, Gideon Kye-Duodu & Fred Newton Binka. (2016) Linear trends and seasonality of births and perinatal outcomes in Upper East Region, Ghana from 2010 to 2014. BMC Pregnancy and Childbirth 16:1.
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Andrea Rishworth, Elijah Bisung & Isaac Luginaah. (2016) “It's Like a Disease”: Women's perceptions of caesarean sections in Ghana's Upper West Region. Women and Birth 29:6, pages e119-e125.
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Joachim Aimé Cacko, Kadari Cissé, Madeleine Wayack Pambè, Rachidatou Compaoré & Seni Kouanda. (2016) Evaluation of the implementation and effects of an obstetric kit used in the Adamawa region of Cameroon. International Journal of Gynecology & Obstetrics 135:S1.
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Tieba Millogo, Eustasius Musenge, Daniel K. Azongo, Seni Kouanda & Abraham Rexford Oduro. (2016) Trends and changes in home deliveries in Kassena–Nankana districts in northern Ghana: Results from repeated cross‐sectional surveys. International Journal of Gynecology & Obstetrics 135:S1.
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John Kuumuori Ganle, Raymond Fitzpatrick, Easmon Otupiri & Michael Parker. (2015) Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana. The International Journal of Health Planning and Management 31:4.
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Barbara McPake & Kara Hanson. (2016) Managing the public–private mix to achieve universal health coverage. The Lancet 388:10044, pages 622-630.
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Nicole Atchessi, Valéry Ridde & Maria-Victoria Zunzunegui. (2016) User fees exemptions alone are not enough to increase indigent use of healthcare services. Health Policy and Planning 31:5, pages 674-681.
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Evaline Lang'at & Lillian Mwanri. (2016) Service users' perspectives on free maternal health services in Malindi District, Kenya. African Journal of Midwifery and Women's Health 10:2, pages 90-95.
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Tiziana Leone, Valeria Cetorelli, Sarah Neal & Zoë Matthews. (2016) Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis. BMJ Open 6:1, pages e009692.
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Evaline Lang’at & Lillian Mwanri. (2015) Healthcare service providers’ and facility administrators’ perspectives of the free maternal healthcare services policy in Malindi District, Kenya: a qualitative study. Reproductive Health 12:1.
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Augustina Koduah, Han van Dijk & Irene Akua Agyepong. (2015) The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health Research Policy and Systems 13:1.
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Fahdi Dkhimi, Werner Soors & Bart Criel. (2015) Foreword. BMC Health Services Research 15:S3.
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M. Aikins, R. Aryeetey, P. Dako-Gyeke, P.B. Adongo & L. McGough. (2015) Socio-economic differences in cost of pregnancy-related health services in the peri-urban Accra, Ghana. Journal of Public Health 37:3, pages 540-546.
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Britt McKinnon, Sam Harper & Jay S. Kaufman. (2015) Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone. Social Science & Medicine 135, pages 117-123.
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M. Amoakoh-Coleman, E. K. Ansah, I. A. Agyepong, D. E. Grobbee, G. A. Kayode & K. Klipstein-Grobusch. (2015) Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: a cross-sectional study of population data. BMJ Open 5:5, pages e007810-e007810.
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Mai Do, Rieza Soelaeman & David R. Hotchkiss. (2014) Explaining Inequity in the Use of Institutional Delivery Services in Selected Countries. Maternal and Child Health Journal 19:4, pages 755-763.
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Patience A. Afulani. (2015) Rural/Urban and Socioeconomic Differentials in Quality of Antenatal Care in Ghana. PLOS ONE 10:2, pages e0117996.
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John K Ganle, Michael Parker, Raymond Fitzpatrick & Easmon Otupiri. (2014) Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study. International Journal for Equity in Health 13:1.
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Aline Philibert, Valéry Ridde, Aristide Bado & Pierre Fournier. (2014) No effect of user fee exemption on perceived quality of delivery care in Burkina Faso: a case-control study. BMC Health Services Research 14:1.
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Jelena Arsenijevic, Milena Pavlova & Wim Groot. (2013) Out‐of‐pocket payments for public healthcare services by selected exempted groups in Serbia during the period of post‐war healthcare reforms. The International Journal of Health Planning and Management 29:4, pages 373-398.
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Theresa Diaz, Asha S George, Sowmya R Rao, Peter S Bangura, John B Baimba, Shannon A McMahon & Augustin Kabano. (2013) Healthcare seeking for diarrhoea, malaria and pneumonia among children in four poor rural districts in Sierra Leone in the context of free health care: results of a cross-sectional survey. BMC Public Health 13:1.
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Tinoaga Laurent Ouedraogo, Alphonse Kpozehouen, Yolaine Gléglé-Hessou, Michel Makoutodé, Jacques Saizonou & M’Tatouwa Tchama-Bouraima. (2013) Évaluation de la mise en œuvre de la gratuité de la césarienne au Bénin. Santé Publique Vol. 25:4, pages 507-515.
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Roger A. Atinga & Anita A. Baku. (2013) Determinants of antenatal care quality in Ghana. International Journal of Social Economics 40:10, pages 852-865.
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Özge Tunçalp, Cynthia Stanton, Arachu Castro, Richard Adanu, Marilyn Heymann, Kwame Adu-Bonsaffoh, Samantha R. Lattof, Ann Blanc & Ana Langer. (2013) Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic. PLoS ONE 8:5, pages e60761.
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Manuela De Allegri, Valéry Ridde, Valérie R Louis, Malabika Sarker, Justin Tiendrebéogo, Maurice Yé, Olaf Müller & Albrecht Jahn. (2012) The impact of targeted subsidies for facility-based delivery on access to care and equity – Evidence from a population-based study in rural Burkina Faso. Journal of Public Health Policy 33:4, pages 439-453.
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M. MariappanHarshad P. Thakur. (2012) User Fee Management in India. Journal of Health Management 14:2, pages 221-238.
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KATHRYN H. JACOBSEN, HAFSA A. ABDIRAHMAN, RASHID ANSUMANA, ALFRED S. BOCKARIE, UMARU BANGURA, DAVID HENRY JIMMY, ANTHONY P. MALANOSKI, ABU JAMES SUNDUFU & DAVID A. STENGER. (2012) Home birth and hospital birth trends in Bo, Sierra Leone. Acta Obstetricia et Gynecologica Scandinavica 91:6, pages 750-753.
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J. Akazili, B. Garshong, M. Aikins, J. Gyapong & D. McIntyre. (2012) Progressivity of health care financing and incidence of service benefits in Ghana. Health Policy and Planning 27:suppl 1, pages i13-i22.
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L. C. Steinhardt, I. Aman, I. Pakzad, B. Kumar, L. P. Singh & D. H. Peters. (2011) Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan. Health Policy and Planning 26:Suppl. 2, pages ii92-ii103.
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F. Ponsar, M. Van Herp, R. Zachariah, S. Gerard, M. Philips & G. Jouquet. (2011) Abolishing user fees for children and pregnant women trebled uptake of malaria-related interventions in Kangaba, Mali. Health Policy and Planning 26:Suppl. 2, pages ii72-ii83.
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M. Nimpagaritse & M. P. Bertone. (2011) The sudden removal of user fees: the perspective of a frontline manager in Burundi. Health Policy and Planning 26:Suppl. 2, pages ii63-ii71.
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Valéry Ridde, Bruno Meessen & Seni Kouanda. (2011) L'abolition sélective du paiement direct en Afrique subsaharienne : une opportunité pour le renforcement des systèmes de santé ?. Santé Publique Vol. 23:1, pages 61-67.
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Manuela De Allegri, Valéry Ridde, Valérie R. Louis, Malabika Sarker, Justin Tiendrebéogo, Maurice Yé, Olaf Müller & Albrecht Jahn. (2011) Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso. Health Policy 99:3, pages 210-218.
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