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Community-based health insurance and access to maternal health services: evidence from three West African countries
- Authors:
- SMITH Kimberley V., SULZBACH Sara
- Journal article citation:
- Social Science and Medicine, 66(12), June 2008, pp.2460-2473.
- Publisher:
- Elsevier
Community-based health insurance (CBHI) has been incorporated into the health financing strategies of governments and communities in several Sub-Saharan African countries. Despite the support for and proliferation of CBHI schemes in this region, empirical evidence on how CBHI impacts access to health care, particularly maternal health services, is very limited. Recent household surveys in three West African countries – Senegal, Mali, and Ghana – are used to examine the relationship between CBHI membership and access to formal sector maternal health care. It is found that membership in a CBHI scheme is positively associated with the use of maternal health services, particularly in areas where utilization rates are very low and for more expensive delivery-related care. Findings suggest, however, that membership in a CBHI scheme is not sufficient to influence maternal health behaviours – it is the inclusion of maternal health care in the benefits package that makes a difference. While many questions remain about CBHI, this study provides preliminary evidence suggesting that CBHI is a potential demand-side mechanism to increase maternal health care access. However, complementary supply-side interventions to improve quality of and geographic access to health care are also critical for improving health outcomes in this region
“He will ask why the child gets sick so often”: the gendered dynamics of intra-household bargaining over healthcare for children with fever in the Volta Region of Ghana
- Authors:
- TOLHURST Rachel, et al
- Journal article citation:
- Social Science and Medicine, 66(5), March 2008, pp.1106-1117.
- Publisher:
- Elsevier
This paper explores the gendered dynamics of intra-household bargaining around treatment seeking for children with fever revealed through two qualitative research studies in the Volta Region of Ghana, and discusses the influence of different gender and health discourses on the likely policy implications drawn from such findings. Methods used included focus group discussions, in-depth and critical incidence interviews, and Participatory Learning and Action methods. The authors found that treatment seeking behaviour for children was influenced by norms of decision-making power and ‘ownership’ of children, access to and control over resources to pay for treatment, norms of responsibility for payment, marital status, household living arrangements, and the quality of relationships between mothers, fathers and elders. However, the implications of these findings may be interpreted from different perspectives. Most studies that have considered gender in relation to malaria have done so within a narrow biomedical approach to health that focuses only on the outcomes of gender relations in terms of the (non-)utilisation of allopathic healthcare. However, it is argued that a ‘gender transformatory’ approach, which aims to promote women's empowerment, needs to include but go beyond this model, to consider broader potential outcomes of intra-household bargaining for women's and men's interests, including their livelihoods and ‘bargaining positions’.
Access and utilisation of safe motherhood services of expecting mothers in Ghana
- Author:
- APPIAH-KUBI Kojo
- Journal article citation:
- Policy and Politics, 32(3), July 2004, pp.387-407.
- Publisher:
- Policy Press
Despite more than a decade of the Safe Motherhood Initiative in Ghana, access and utilisation levels of modern healthcare services by expecting mothers remain very low, even though considerable progress has been made over time. Using Andersen's behavioural model as the conceptual framework, the study examines, with data from Ghana DHS, user-related social, economic and demographic factors that influence access and utilisation of safe motherhood services. The bivariate and multivariate analyses reveal that education of mother and spouse, regional location of residence and socioeconomic status exert the strongest impact and are significant in predicting the use of safe motherhood services and thus differentials in health among expecting mothers. The implications of these results for improved maternal healthcare are discussed.