MDG 5, HUMAN RIGHTS, AND MATERNAL HEALTH IN AFRICA
in the region have followed suit. In 2006, Burundi introduced free health
care for pregnant women and children less than five years old. 134 The result
has been increased utilization of services and, presumably, declining
maternal deaths and deaths of children under the age of five. 135 Zambia
extended a similar scheme to its rural district the same year. 136 In Burkina
Faso, an official government policy reduced the fee for deliveries by eighty
percent in 2006.137 The following year, Kenya announced free deliveries in
the nation’s health facilities. 138
Free or subsidized health care for any vulnerable group is a surefire way
to increase service utilization for the simple reason that the greatest
impediment to access, namely lack of cash, is thereby eliminated. 139 If
Ghana’s experience is of any significance, it is that exemption policies lead
directly to the increased utilization of health services, which inevitably
results in reducing or eliminating the morbidities or mortalities that could
have resulted in absence of such services, be it antenatal care or any other
type of care. 140
H. Inadequate Budgetary Allocation
Related to the problem of poverty at the individual level is poor
budgetary allocations for maternal health by national governments. This is
a system-wide problem. As a subset or branch of the broader health system,
maternal health can only be as financially supported as the health system
itself. The availability of reproductive health services, including antenatal
care, deliveries, and postnatal care, depends on the magnitude of resources
set aside for health care in national budgets. Yet, on this critical point, the
134. Id.
135. Id.
136. Id.
137. Id.
138. Id.
139. See Obiajulu Nnamuchi, The Nigerian Social Health Insurance System and the
Challenges of Access to Health Care: An Antidote or a White Elephant?, 28 MED. L. 125,
154-57 (2009) (discussing poverty as an impediment to access to care).
140. Suzanne Penfold et al., Evaluation of the Delivery-Fee-Exemption Policy in
Ghana: Population Estimates of Changes in Delivery Service Utilisation in Two Regions, 41
GHANA MED. J. 108 (2007); see also Adam Nossiter, In Sierra Leone, New Hope for
Children and Pregnant Women, N.Y. TIMES, July 17, 2011, at A1 (reporting that since the
government of Sierra Leone waived hospital fees for women and children, the country has
recorded a monumental improvement in the health of these vulnerable populations, including
an upswing of 214 percent in the number of children less than five years old receiving care at
health facilities, a sixty-one percent decline in mortality in difficult pregnancies at hospitals,
and an eighty-five percent plunge in malaria-related fatality rate amongst children treated in
health facilities).
