Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.
Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.
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DOI：
10.1186/s12939-014-0089-z
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发表时间：
2014-11-01
影响因子：
4.8
通讯作者：
Otupiri E
中科院分区：
文献类型：
--
作者：
Ganle JK;Parker M;Fitzpatrick R;Otupiri E
在获得和利用孕产妇保健服务方面的不平等阻碍了在实现与孕产妇保健有关的千年发展目标方面取得进展。本研究的目的是审查加纳孕产妇保健服务的利用程度，以及在实施用户费用豁免政策后，获得和利用服务方面的不平等是否已经消除，该政策旨在减少获得服务的财政障碍，减少获得服务方面的不平等，并改善分娩服务的获得和利用。我们分析了2007年加纳孕产妇健康调查的数据，以了解获得和利用孕产妇健康服务的不公平性。在衡量不公平现象时，使用了频率表和交叉表，按区域、居住地和选定的社会人口变量比较服务利用率。调查结果表明，在政策实施后（2003-2007年），获得和利用熟练的产前、分娩和产后护理服务的机会略有增加。然而，地理区域、城市和农村地区以及不同的社会人口、宗教和族裔群体之间存在着巨大的不平等梯度。城市妇女（40%）多于农村妇女，财富最高五分之一的妇女比最低五分之一的妇女多53%，表现最好地区的妇女多38%（中部地区）比最坏的（上东区），至少受过中等教育的妇女比没有受过正规教育的妇女多48%，在调查前五年获得和使用熟练孕产妇保健服务的所有组成部分。我们的研究结果提出了问题的潜在公平性和加纳的用户费豁免政策的分配利益，以及非金融障碍或考虑的作用。免除产妇保健服务的使用费是改善产妇保健机会的一个有希望的政策选择，但这本身可能不足以确保在加纳公平获得产妇保健服务。要确保公平获得保健服务，就必须超越免除使用费的范围，解决更广泛的供求因素和健康的社会决定因素问题，包括重新分配保健资源和服务，并纠正妇女在社区中的弱势地位。
Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services. We analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables. Findings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003–2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana’s user-fee exemption policy, and the role of non-financial barriers or considerations. Exempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to maternal health services in Ghana. Ensuring equity in access will require moving beyond user-fee exemption to addressing wider issues of supply and demand factors and the social determinants of health, including redistributing healthcare resources and services, and redressing the positional vulnerability of women in their communities.
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作者：
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