Returns on health investment

Abstract

Chapter 1: Effect of the Free Delivery Healthcare Policy on Under-five Deaths in Ghana. User fee elimination policies have been implemented by developing countries to eliminate financial obstacles that limit health care service utilization by pregnant women. Numerous studies reveal positive association between the delivery fee elimination policy on maternal health service uptake, however there are rare studies that investigate its long-term effect on child mortality especially its impact on both neonatal and infant deaths and the benefit incidence of the policy. This study investigates the effect of the free delivery care policy in Ghana and its effect on child death using the 2003 and 2008 Ghana demographic and health survey (GDHS) data set. Using the difference-in-difference estimation approach, we find the free delivery care policy significantly lowers the probability of neonatal, and infant deaths by 3.3, and 3.6 percentage points respectively in the treated regions. Thus, the likelihood of infant death in the treatment regions is lower compared to the control regions during the pilot period. We find the free maternal delivery care policy to be cost-effective, with an estimated $820.7 cost per infant death averted. Chapter 2: Effect of Healthcare Quality Initiative on Maternal Healthcare Service Utilization and Pregnancy Outcome: A Case Study of Spring-Ghana Project. We study the effect of the Spring-Ghana project on maternal healthcare service utilization and pregnancy outcome. The aim of the spring Ghana project was to improve the health of households with pregnant women and children within thousand days of life. As a result, spring introduced several strategies including quality improvement (QI) initiative, where QI teams used PDSA cycle to identify nutrition gaps, brainstorm for change ideas and then test the change ideas. Low antenatal attendance was one of the major gaps identified by the facility teams and changed ideas generated and tested. This study examines the effect of the project on maternal healthcare service utilization and pregnancy outcome. Using the 2017 GMHS dataset and the difference-in-difference approach, we find strong positive association of the project impact on the probability of antenatal care attendance at least one visit and four and more visits by 23 and 11 percentage points respectively and facility delivery by 24 percentage points. We also find that the project reduces the probability of miscarriage by 10 percentage points, and a reduction in the expected number of stillbirths by 27 percent. The findings indicate that pregnant women in the intervention regions were more likely to utilize maternal health service, which translated into improved live births than in the non-intervention regions. Chapter 3: Effect of the Community-Based Health Planning and Services on Anemia and Acute Malnutrition among the Vulnerable in Ghana. We study the impact of the community-based health planning and services (CHPS) model implemented by JICA in the upper west region of Ghana on anemia prevalence in children less than five years and women of 15 to 49 years of age. Using the Ghana demographic and health survey dataset and the difference-in-difference approach, we find a reduction in the likelihood of anemia prevalence among children less than five years and women of 15 to 49 years of age by 15 and 19 percentage points respectively. We also find a reduction in the probability of acute malnutrition in children less than five years by 7 percentage points. The results indicate that the JICA model of CHPS implementation is effective in the reduction of anemia and acute malnutrition prevalence as compared to the traditional model. We find the JICA CHPS project to be very cost-effective in averting anemia prevalence, with an estimated cost of $8 and $6 per year among children less than five years and women of reproductive age respectively.