Ghana’s hope of meeting the Millennium Development Goal 5, to improve maternal healthcare is under threat despite the introduction of programmes such as the Free Maternal Care Initiative (FMHCI) in July 2008, to accelerate the process.

A survey conducted by the Alliance for Reproductive Health Rights as part of its Transparency and Accountability Project and copied to the Ghana News Agency indicated many women continue to deliver their babies outside health facilities.

The study utilised a Citizen Report Card (CRC) to assess the FMHCI as well as to ascertain gaps in its implementation.

It revealed that issues of hidden cost at the level of the health facility discouraged pregnant women from accessing the free maternal care.

The CRC is a social accountability tool used to assess public service delivery in terms of quality, reliability, satisfaction, corruption and usage.

According to the statement, the study sought to, among others, understand the extent to which rural women in three districts were benefitting from the free maternal health care initiative.

It also ascertained the existence of corruption, problem redress, factors affecting access and usage, levels of satisfaction and the quality and reliability of skilled delivery services by September 30, 2012.

The study was conducted within three regions in three administrative districts – Juaboso (Western Region); Offinso (Ashanti Region) and Bongo (Upper East Region) based on the relatively low uptake of skilled delivery.

It was apparent that the mere removal of usage charges was not enough to persuade a significant majority of women to utilise delivery care services because many of them did not have the wherewithal to pay for the related hidden charges or costs.

These charges included payments for antenatal cards, hospitals supplies like soap, beddings, Dettol, cost payment for burying placenta, mackintosh, food and some items, which should be available, but unfortunately were not supplied at health centres.

The study noted that: “Health Promotion Educational campaigns aimed at improving comprehensive knowledge about the entire benefit package of the Free Maternal Healthcare Initiative should be strengthened”.

“The campaign should be targeted towards giving reliable, factual and comprehensive information and describing the full range of FMHCI as well as benefits of accessing free delivery care,” it added.

The study recommended that the implementation of the policy as evidenced by the responses of both health officials and patients alike indicated that the operational barriers that hindered the successful implementation of the initiative must be addressed in a holistic manner in order to ensure progress.

“Hidden cost associated with deliveries, which should be available, but unfortunately, are not available at health centres; among others must be removed if indeed the initiative was meant to be free,” the study concluded.