Contextualizing the Impact of ‘free’ Maternal Healthcare Policy Implementation: An Intrinsic Case Analysis of Maternal Healthcare Utilization and Stillbirth in Ghana

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Abstract Background: The inception of the 'Free’ Maternal Health Care Policy (FMHCP) in Ghana since 2008 has seen drastic improvement in maternal healthcare utilization, particularly antenatal care uptake and skilled delivery utilization. However, its impact against late pregnancy outcomes has yet to be examined contextually.Purpose: This study aimed to describe the implications of the ‘free’ policy funding constraints on maternal healthcare utilization and explain how factors play to contribute to stillbirth despite the increase in maternal healthcare utilization. Methods: The study adopted an intrinsic-case study method using qualitative techniques to collect primary data through one-on-one interviews with service providers, and focus group discussions for pregnant women. The study then interviewed an expert in healthcare practice and policy implementation as a key informer to triangulate the data for analysis. Deductive thematic analysis guided the approach to writing the report, where sub-themes also emerged inductively and are reported with verbatim quotes to aid explanatory power.Results: The study found that within increased skilled attendance, comes top-up payments for medicines and laboratory services among pregnant women despite the policy being described as ‘free’. The study also found that routine medicines such as folic acid, ferrous sulphate and multivitamin tablets are often in short supply in the ‘free’ policy credentialed facilities and affecting service provision and quality of care.Conclusion: We conclude that the increase in maternal healthcare utilization do not necessarily translate to desired late pregnancy outcomes in its current form, particularly within the context of acute shortages of medicine commodities. The Ministry of Health and its agencies should perhaps set agendas to ensure regular supply of drug commodities in hospitals and health centers to boost quality of care.

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