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Start-stop funding, its causes and consequences : a case study of the delivery exemptions policy in Ghana

By Sophie Witter and Sam Adjei


This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positive results, the delivery exemptions policy quickly ran into implementation problems caused by inadequate funding. They suggest that facility and district managers bear the brunt of the damage that is caused when benefits that have been promised to the public cannot be delivered. There can be knock-on effects on other public programmes too. Despite these problems, start-stop funding and under-funding of public programmes is more the norm than the exception. Some of the factors causing erratic funding—such as party politics and intersectoral haggling over resources—are unavoidable, but others, such as communication and management failures can and should be addressed.This work was undertaken as part of an international research programme— Initiative for Maternal Mortality Programme Assessment (IMMPACT), funded by the Bill & Melinda Gates Foundation, the Department for International Development, the European Commission and USAID

Topics: sustainability, funding, exemptions, deliveries, Ghana
Publisher: Wiley Interscience
Year: 2007
OAI identifier:

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  2. (2005). Evaluation of the Free Delivery Policy in Ghana: Findings From Key Informant Interviews.
  3. (2004). Ghana health sector five year programme of work (2002– 2006)—an in-depth review of the health sector response to maternal mortality in Ghana by 2003. UNFPA/MoH:
  4. (1992). Health Economics in an Irrational World: The View From a Regional Health Administration in Ghana, Doctor in Philosophy, Liverpool School of Tropical Medicine.
  5. (2006). Health Financing Revisited: A Practitioner’s Guide. World Bank: Washington, D.C. Copyright #
  6. (2005). I. Policy Brief: Implementation of the Free Delivery Programme in Ghana. Aberdeen, Noguchi Institute and IMMPACT. Ref Type:
  7. (2004). National Health Insurance Policy Framework for Ghana (revised version). Ministry of Health:
  8. (2004). Poverty and maternal mortality: what’s the link? Keynote address delivered at Annual Research Meeting, NMIMR,
  9. (2000). Sector-Wide Approaches for Health Development: A Review of Experience. Recommendations on Implementing Sector-Wide Policies in the Health Sector. World Health Organisation:
  10. (1995). Sustaining Primary Health Care.

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