Challenges of medical commodity availability in public and private health care facilities in the Upper East Region of Ghana: a patient-centered perspective

Who pays more? Exploring cost disparities in medication abortion access across socio-demographic groups in Ghana

BACKGROUND

Medication abortion (MA) may be accessed covertly in private pharmacies and clinics due to abortion-related stigma. Stigmatization may lead to information asymmetry, resulting in price discrimination. The existing literature on abortion in Ghana has primarily focused on factors associated with abortion stigma. However, the potential variations in MA cost have not been explored. Thus, we aim to explore the potential disparities in MA cost based on women's socio-demographic status in Ghana.

METHODS

We used data from a study that recruited women who accessed MA using mifepristone and misoprostol combination from selected private pharmacies and clinics in Ghana. The study employed a non-inferiority and prospective design, and women were recruited as they exited the selected facilities after obtaining the MA pills. Our final analysis included 929 pharmacy clients and 1,045 clinic clients. To understand the variability in MA cost, we initially conducted two decomposition analyses using the variance and Blinder-Oaxaca techniques, followed by linear regressions to identify the socio-demographic factors that predict MA cost.

RESULTS

The average costs of MA were approximately US$ 46.00 and US$ 24.00 for the clinic and pharmacy groups, respectively. Additionally, the cost varied between pharmacy and clinic groups and within each group. A greater segment of the variation among the clinic group stemmed from between facilities (78 percent), whereas, among the pharmacies, the bigger share came from within facilities (57 percent). Regression results further indicate that the cost of MA increased among women with higher education, those who have not been in a union with a partner and those who accessed MA in clinics.

CONCLUSIONS

MA cost in Ghana is largely based on providers' discretion and at the facility's management level. Additionally, the cost differs by women's socio-demographic attributes. To reduce the disparities in MA costs, developing guidelines to address the health system challenges regarding MA provision and access is important. Educational programs on MA access, provision and legal framework could also reduce abortion-related stigma and cost variations.

Barriers to access of maternal health commodities among pregnant women in public health facilities in Ubungo Municipal Council, Tanzania

Background

Access to maternal health commodities improves maternal outcome and reduce maternal deaths. Tanzania has put in place the fee exemption policy for mothers to access maternal health commodities for free, however, the implementation of user fee exemption has been challenging. Therefore, this study explored the barriers to access of maternal health commodities among pregnant women in public health facilities at Ubungo Municipal Council, Tanzania.

Methods

This was a descriptive qualitative study conducted from January to February 2023. Both focus group discussions and key informant interviews were conducted. These involved 72 pregnant women and 40 health care providers respectively. A purposive sampling technique was used to selected facilities and study participants. Thematic analysis was used to analysis data.

Results

Findings from this study indicated that fear of stigma and discrimination, decision-making autonomy, additional costs and stock out of health commodities were the main barriers to accessing maternal health commodities. Furthermore, both pregnant women and health care providers reported that shortage of health commodities and the inadequacy of service providers, which led to long waiting times, also hinder access to health commodities.

Conclusion

Improving health commodities availability, and increasing the number of service providers are important factors to consider to improve access to maternal health commodities. In addition, factors such as fear of stigma and discrimination should also be addressed to improve maternal health.