Date of Conferral

12-2-2025

Date of Award

December 2025

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Stacy-Ann Christian

Abstract

Abstract In Ghana, the user fee exemption policy, implemented in 2008, provides free maternal health services, which are a key component of the National Health Insurance Scheme (NHIS). Grounded in the Health Access Livelihood Framework, the purpose of this study was to determine the association between the user fee exemption policy and the utilization of antenatal care, facility-based delivery, and postnatal care in Northern Ghana, while controlling for sociodemographic factors. A quantitative approach was employed using secondary data from the Ghana Demographic and Health Surveys, encompassing women of reproductive age (15–49 years; N = 6,948). Logistic regression was used to determine if the independent variable, Year, is associated with the likelihood of patients receiving adequate facility delivery and postnatal care. The odds of facility delivery increased by 5% each subsequent year (p = .01, OR = 1.05, 95% CI [1.126, 1.149], Nagelkerke R² = .653). The odds of receiving postnatal care increased by 8.0% for each subsequent year over the observation period (p < .001, OR = 1.08, 95% CI [1.020, 1.040], Nagelkerke R² = .057). Conversely, linear regression results indicated a small but statistically significant decline in antenatal visits across the observed years (B = –0.02, p = .012). Results underscore the need for comprehensive, context-specific interventions beyond financial incentives to enhance equitable access and utilization of maternal health services in resource-limited settings. These findings can inform data-driven policies and targeted interventions to improve maternal healthcare utilization in Ghana.

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