The Association between Health Insurance Coverage and Skilled Birth Attendance in Ghana: A National Study
Skilled birth attendance (SBA) is a key health intervention used by roughly two-thirds of women in Ghana. The National Health Insurance Scheme (NHIS) provided by the Government of Ghana is widely expected to improve maternal health outcomes by removing financial barriers to health services. Using data from the 2011 national Ghana Multiple Indicator Cluster Survey implemented by the Ghana Statistical Services and UNICEF, we examine the effect of insurance on SBA using a multivariate logistic model, controlling for a number of enabling and predisposing factors and past experience with the health system. Our sample is 2 528 women who had a birth in the two years before the survey. Our results show that women with health insurance are 74% more likely to use SBA than women without health insurance. Results also underscore that health insurance, while it eliminates a monetary barrier, does not solve health services availability problems and widespread geographic disparities in coverage of SBA persist. Additionally, we find that higher parity women and poor women are much less likely to use SBA and should be the focus of health interventions in order to fulfil development goals. Health insurance may indeed be a useful mechanism to improve coverage of SBA though further work to understand the effect of health insurance on other maternal outcomes is warranted.