‘Your health our concern, our health whose concern?’: perceptions of injustice in organizational relationships and processes and frontline health worker motivation in Ghana
SUMMARY BACKGROUND In Ghana, a universal free delivery policy was implemented to improve access to delivery care in health facilities, thereby improving access to skilled attendance and reducing maternal mortality. OBJECTIVE A confidential enquiry was conducted to ascertain if changes had occurred in the care provided by reviewing the care given to a sample of maternal deaths before and after introduction of the policy. METHOD Twenty women who died as a result of pregnancy-related complications (maternal deaths) in selected hospitals in two regions were assessed by a clinical panel, guided by a maternal death assessment form. Unlike the traditional confidential enquiry process, both adverse and favourable factors were identified. FINDINGS Clinical care provided before and after the introduction of the fee exemption policy did not change, though women with complications were arriving in hospital earlier after the introduction of the policy. On admission, however, they received very poor care and this, the clinical panel deduced could have resulted in many avoidable deaths; as was the case before the implementation of the policy. Consumables, basic equipment and midwifery staff for providing comprehensive emergency obstetric care were however found to be usually available. CONCLUSION Our findings suggest that the already poor delivery care services women received remained unchanged after introduction of the policy.