Universal Coverage in Developing Countries: A Summative Evaluation of Maternal Policies in Ghana and Burkina Faso

The Word Health Organization (WHO) has declared health to be a fundamental human right, yet more than 400 million people around the world do not have access to essential health services. Millions of Africans are unable to access or afford needed services without sustaining economic hardship. Sub-Saharan Africa is behind the rest of the world on coverage of essential health services such as planning, immunization, and sanitation and continues to grapple with higher rates of child mortality, maternal death, and communicable diseases. Despite bearing 25 percent of the world’s disease burden, the region only retains 3 percent of its doctors. Universal health coverage (UHC) has gained attention in recent years as a viable means of ensuring access to care for all, including the most vulnerable and those residing in developing parts of the world. The underlying assumption is that by assuring basic health care coverage for all, UHC can minimize impoverishment resulting from catastrophic health expenditures. Many low-income countries have taken the lead in implementing universal health coverage reforms, among them Ghana and Burkina Faso – a Sub-Saharan country. Ghana passed the National Health Insurance Scheme (NHIS) in 2003 with the aim of moving towards universal health care coverage and improving the quality of health of its population. Ghana’s NHIS is a tax-funded national health insurance system that provides financial protection and expands health care coverage to the citizenry (Health Systems 20/20 Project and Research & Development Division of the Ghana Health Service, 2009). In 2008, this law was amended to include a maternal free care policy that extended care services to all pregnant women and their newborns free of charge. On the other side, Burkina Faso adopted a policy in 2006 that subsidized deliveries and emergency obstetric care. The subsidy for deliveries and emergency obstetric and neonatal care (EmONC) funds 80% of deliveries and caesarean sections, and the patient pays the remainder 20%. The policy entirely exempts those categorized as “the poorest.” Contrary to Ghana, the country did not receive all the support required in formulating the plan, and those in charge had to learn through trial and error. This study will evaluate the effectiveness of each program separately at increasing the utilization of maternal health services and at improving child health outcomes. The outcomes evaluated include antenatal, perinatal, and postnatal health care utilization and neonatal and infant mortality