Impact of health care financing reforms on the management of malaria in Ghana

Abstract

Objective: To determine the impact of the introduction of the 'cash and carry' system on how health care providers manage malaria cases in Ghana Design: A cross sectional study of treatment patterns of cases of malaria. Setting: Health services in Ghana changed significantly in 1992, from being virtually free to a 'cash and carry' system in which all patients attending government health services had to pay in full for drugs and services. Staff of private companies and parastatal organisations continue to enjoy free health services at other clinics and hospitals. Subjects: Prescriptions for 9539 cases diagnosed as having malaria at the out-patient departments (OPD) of eight health facilities four in the 'cash and carry' scheme and four outside this scheme were reviewed. Results: The mean (SD) number of drugs prescribed per case of malaria was higher for the 'cash and carry' group than for the 'free for service' group; 4.5±1.3 versus 3.8±1.3 (p value < .001). Second-line antimalarial drugs were however, more often used in the 'free service' group 13.5% versus 7.3% (p value