The Effect of Health Financing Reforms on incidence and management of childhood infections in Ghana: A matching difference in differences impact evaluation

IntroductionIn 2003, Ghana abolished direct out of pockets payments and implemented health financing reforms including the national health insurance scheme in 2004. Treatment of childhood infections is a key component of services covered under this scheme, yet, outcomes on incidence and treatment of these infections after introducing these reforms have not been covered in evaluation studies. Combining propensity score matching and difference in differences technique, this study fills this gap by assessing the impact on the reforms on the two most dominant childhood infections; fever (malaria) and diarrhoea. Methods Nigeria was considered as a control country and using four data points (pre and post reforms periods) from the demographic health surveys, we calculate the probability of treatment based on background covariates. Those treated in Ghana were matched with appropriate controls using kernel matching technique and quality of matching was assessed. A linear probability model which comprises of pre and post health reforms in Ghana and Nigeria was conducted to determine the net impact of child outcomes under study. All analysis were conducted in STATA (psmatch2, psgraph and pstest) and statistical significance was considered when p-value ≤ 0.05. ResultsAfter matching, it was determined that health reforms significantly increased general medical care for children with diarrhoea (25 percentage points) and also for those receiving care specifically in government managed facilities (14 percentage points). Furthermore, there was marginal net impact on access to medical care for children with fever (40 percentage points) and care in government facilities (24 percentage points). Access to antimalarial was also positively impacted after the introduction of these reforms (5 percentage points). Conclusions Introduction of health reforms in Ghana showed marginal effect on some aspects of incidence and treatment of childhood infections. This denotes that introducing health financing reforms can have marginal impact on child health outcomes.