A free maternal health care policy was introduced in Ghana in 2008 to cater for the health needs of pregnant women for the reduction of maternal deaths. Experiences from other regions and countries show that demand- and supply-side factors often affect the success of such policies although this is unknown in this context. The study aimed to assess demand- and supply-side factors affecting the utilisation and provision of services during pregnancy under the policy.
A convergent parallel mixed methods study was undertaken, collecting quantitative and qualitative data. The study was carried out in the Kassena-Nankana East Municipality in Ghana. Questionnaire were used to collect data from women (n=406) who utilised services during pregnancy. Focus group discussions with women (n=10) and in-depth interviews with midwives and nurses (n=25) were also conducted. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were audio-recorded, transcribed and coded using themes and sub-themes.
Both demand- and supply-side factors impacted the use and provision of services. Distance and time to facilities challenged the use of services. Supply-side factors such as laboratory services, equipment, drugs and supplies were not adequately available. Antenatal, childbirth and postnatal services were carried out together in the same rooms at the community-based health planning and services (CHPS) compounds. Emergency transport was also unavailable for referral of emergencies.
Demand- and supply-side factors were reported to impede the use and provision of services. Government and stakeholders should prioritise building as well as expanding the infrastructure of CHPS compounds. Emergency transport for women should also be provided. These together may contribute to improving the use and provision of services, leading to a reduction in maternal deaths and achievement of universal health coverage.