Impact of NHIS on Antenatal Care Attendance in Ghana: Summary of Findings, Conclusions and Recommendations

SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This article is the summary of findings, conclusions and recommendations for a study that sought to evaluate the impact of National Health Insurance on antenatal care attendance among pregnant women in Ghana using the the 2013 Ghana Living Standard Survey Round 6 (GLSS6). This article looks at the summary of findings, conclusions and recommendations for the study

Summary of Findings

The average age of study participants was 28.7 years, with their true mean age lying between 21.89 and 35.51 years.

The mean parity of study participants was 3.18 children. The true value lies somewhere between 1.05 and 5.13 as indicated by a standard deviation of 2.13.

The mean monthly income of the sampled pregnant women was GHS 102.50. A standard deviation of GHS656.75 further suggests some of the pregnant women earn very little or no incomes. Further analysis showed that a massive majority of 2,126 of the 2,587 pregnant women (representing 82.18%) earn between 0 and GHS 99 with only 67 out of the 2,587 pregnant women (2.57 %) reportedly earning between GHS 500 and GHS 999.

Majority of pregnant women in Ghana have basic or no education. This is because those with basic or no education accounted for a whopping 88.98 % of the study participants.

The pregnant women sampled for the study were predominantly employed. Out of 2,587 study participants, 2,336 said they were employed making a significant proportion of 90.3%.

The proportion of pregnant women with valid NHIS card was found to be 63.51 %. Out of the 2,587 study participants, 1,643 of them indicated that they do hold a valid NHIS card, while 144 said they don't.

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Factors that were observed to be significantly associated with antenatal care attendances were NHIS enrollment, age, educational status, and area of residence.

Meanwhile, factors that were identified to have a significant effect on antenatal care attendance among pregnant women in Ghana were age, parity, income, marital status (specifically consensual relationships), educational status (specifically secondary education), ethnicity (specifically Gurma, Mole-Dagbani, Grusi).

Pregnant women in consensual relationships were significantly less likely to attend antenatal care since the AOR for consensual as a predictor in relation to antenatal attendance was 0.40, a figure less than 1.

Pregnant women with secondary education as their highest academic qualification attained were more likely to attend antenatal care than others with their highest academic qualification being basic or tertiary education.

Age as a predictor was significantly more likely to engender NHIS enrollment among pregnant women in Ghana than parity and income.

Among the three levels of education, using unadjusted odds ratio, basic education was found to be the strongest predictor of NHIS enrollment, followed by secondary and then tertiary education. However, using the adjusted odds ratios, basic, secondary and tertiary educational levels were observed to be insignificant predictors of NHIS enrollment.

Using unadjusted odds ratio pregnant women living in rural areas are more likely to enroll in NHIS than urban dwellers since UOR was greater than 1 and significant. However, when the odds ratio was adjusted for, the AOR for rural area of residence was 1.16 (95% CI: 0.96-1.47; p = 0.23) which was insignificant.

Unemployed pregnant women were more likely to enroll in NHIS than employed pregnant women, but then this difference in likelihood is insignificant since AOR for unemployed pregnant women was observed to be 1.24 (95% CI: 0.96-1.61; p = 0.093).

Using UOR, pregnant women who have never been married were significantly less likely to enroll in NHIS than pregnant women who were married, in consensual relationships, divorced or widowed. Using the AOR, pregnant women in consensual relationships (AOR = 1.18; 95% CI: 0.92-1.53; p = 0.232) were insignificantly more likely to enroll in NHIS than pregnant women who were married, have never been married, divorced or widowed.

Pregnant women belonging to the ethnic groups, Mole Dagbani and Grusi are significantly more likely to enroll in NHIS than Akan, Ga-Dangbe, Ewe, Guan, or Gurma pregnant women. Between Mole-Dagbani and Grusi pregnant women, Grusi pregnant women exhibited a greater propensity to enroll in NHIS. This is because the UOR for Grusi (UOR = 2.08) was greater than that for the Mole-Dagbani (UOR = 1.47).

Pregnant women from Central, Volta, Eastern, Brong-Ahafo, Northern, Upper East and Upper West regions were found to be more likely to enroll in NHIS than those pregnant women from Greater Accra and Ashanti Region. This observation could be due to the ability of most pregnant women from these regions to afford upfront payment for healthcare services considering the fact that these two regions are arguably the richest in the country.

Pregnant women observing traditional religion were significantly more likely to enroll for NHIS than those pregnant women who are Protestants, Catholics or Islamic. This is because traditional religion showed an UOR of 1.77 (95% CI: 1.08-2.89; p = 0.023). Using AOR, Protestant pregnant women were the least likely to enroll for NHIS as the Protestant predictor recorded AOR of 0.88 (95% CI: 0.56- 1.38; p < 0.05), but then this likelihood was not statistically significant.

The NHIS enrollment had a significant effect on antenatal care attendance as evinced by an adjusted odds ratio of 2.19 (95 % CI: 1.31-3.67; p = 0.003). The foregoing result further implies that pregnant women who are NHIS cards holders are significantly far more likely to attend antenatal care than those who are not.

Conclusions

The proportion of pregnant women with valid NHIS card was found to be 63.51 %.

The factors that were observed to be significantly associated with antenatal care attendances were found to be NHIS enrollment, age, education, and area of residence.

Meanwhile, factors that were identified to have a significant effect on antenatal care attendance among pregnant women in Ghana were age, parity, income, marital status, educational status and ethnicity.

The factors significantly associated with NHIS enrollment were observed to be educational status, area of residence, marital status, ethnicity and religion.

NHIS enrollment had a significant effect on antenatal care attendance.

Recommendation

Since majority of the pregnant women were observed to be based in rural areas, it stands to reason that there is perhaps more pregnant women in rural areas than in urban areas, possibly at any point in time. There is therefore the need to build more hospitals and clinics in rural areas to attend to the needs of the majority of pregnant women found in rural areas.

As the proportion of pregnant women with valid NHIS cards still remains below 100 % at 63.51%, it is strongly advised that more should be done to incentivize more pregnant women enroll in the NHIS program. Furthermore, since the findings from the study revealed that the factors significantly associated with NHIS enrollment were educational status, area of residence, marital status, ethnicity and religion. There is therefore the need to incorporate these factors during the designing of the interventions aimed at elevating NHIS enrollment among pregnant women.