Ghana’s hopes of meeting the Millennium Development Goal 5 on improving maternal healthcare are under threat despite the introduction of programmes such as the Free Maternal Care initiative in July 2008 to accelerate the achievement of the target.

This came to light at the completion of a survey conducted by the Alliance for Reproductive Health Rights (ARHR) as part of its Transparency and Accountability Project (TAP) in three districts across three regions in the country.

The evidence gathered indicated that many Ghanaian women continue to deliver their babies outside health facilities and/or without qualified health personnel, sometimes at the cost of their lives even though antenatal attendance is still high.

The study, which utilized a Citizen Report Card (CRC) to assess the Free Maternal Health Care Initiative (FMHCI) as well as to ascertain gaps in its implementation, 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.

The study sought to, among others, understand the extent to which rural women in three (3)districts are benefitting from the free maternal health care initiative as well as ascertain 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. The selection of the three administrative districts - Juaboso (Western Region); Offinso (Ashanti Region) and Bongo (Upper East Region) - was based on the relatively low uptake of skilled delivery.

It was apparent that, the mere removal of usage charges is not enough to persuade a significant majority of women to utilize delivery care services because, many of them do 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, are not available 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.”

It added that: “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.”

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 hinder the successful implementation of the initiative must be addressed in a holistic manner in order to ensure progress going forward.

“Hidden cost associated with deliveries (antenatal cards, hospital supplies like soap, bedding, food and some items which should be available, but unfortunately, are not available at health centres; among others etc) must be removed if indeed the initiative was meant to be free,” the study concluded.