Pregnant women covered by Ghana's free maternal health care policy still carried an average cost of about GHS590 (US$38) each per pregnancy, a University of Ghana master's thesis has found.
The study surveyed 393 women using antenatal, delivery and postnatal services at Nsawam and Kibi government hospitals in the Eastern Region. All 393 were enrolled in the National Health Insurance Scheme (NHIS). Together they bore costs worth GHS231,737.07 (US$14,950.78).
The free maternal care policy began in 2008. It enrols pregnant women in the NHIS at no charge, to cover antenatal, delivery and postnatal care.
Just over half of the cost (53.3%) was direct spending. That included drugs, admission fees, laboratory tests, scans, transport and food.
The rest (46.7%) was indirect: mostly the value of work women lost while seeking care. Lost working time through absence was the biggest single item, at GHS97,267, about 42% of the total.
The author combined the survey with interviews with 12 mothers, 17 health workers and 10 staff of the National Health Insurance Authority. "It is supposed to be free, but I have to still pay for scan and labs," one mother said. Health workers linked some charges to late NHIA reimbursements and shortages of basic supplies.
Costs were converted at US$1 = GHS15.49, the Bank of Ghana rate the author used at the time of data collection.
The study has clear limits. It covered only two hospitals in one region, so it cannot speak for all of Ghana, as the author acknowledges. Costs were self-reported by mothers and may be affected by recall.
A large part of the total is an estimate of lost earnings, not cash paid at the hospital. Some stage-by-stage averages in the thesis are based only on the women who reported that cost, so they do not add up to the overall average. It is a single master's study, not a national survey.
The author concludes that the policy has raised the use of maternity services and cut home deliveries. But women still face notable direct and indirect costs, which undermine its aim of protecting families financially. She recommends faster NHIA reimbursements to facilities, checks on illegal charges, clearer information for women on what is covered, and help with transport costs.
Source: Janet Nsorpika, MPH thesis, University of Ghana, 2025. Full document: https://ugspace.ug.edu.gh/handle/123456789/44847