Do Infant Birth Outcomes Vary Among Mothers With and Without Health Insurance Coverage in Sub-Saharan Africa? Findings from the National Health Insurance and Cash and Carry Eras in Ghana, West Africa

BACKGROUND Beginning in the late 1960's, and accelerating after 1985, a system known as "Cash and Carry" required the people of Ghana to pay for health services out-of-pocket before receiving them. In 2003, Ghana enacted a National Health Insurance Scheme (NHIS) (fully implemented by 2005) that allowed pregnant women to access antenatal care and hospital delivery services for low annual premiums tied to income. The objective of this study was to compare trends in low birth weight (LBW) among infants born under the NHIS with infants born during the Cash and Carry system when patients paid out-of-pocket for maternal and child health services. METHODS Sampled birth records abstracted from birth folders at the Tamale Teaching Hospital (TTH) were examined. Chi-squared tests were performed to determine differences in the prevalence of LBW. A p-value of ≤ 0.05 was considered statistically significant. Analyses were conducted for selected variables in each year from 2000 to 2003 (Cash and Carry) and 2008 to 2011(NHIS). RESULTS Higher birth weights were not observed for deliveries under NHIS compared to those under Cash and Carry. More than one-third of infants in both eras were born to first-time mothers, and they had a significantly higher prevalence of LBW compared to infants born to multiparous mothers. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Understanding the factors that affect the prevalence of LBW is crucial to public health policy makers in Ghana. LBW is a powerful predictor of infant survival, and therefore, an important factor in determining the country's progress toward meeting the United Nations Millennium Development Goal of reducing under-five child mortality rates (MDG4) by the end of 2015.