Exploring the effects of the withdrawal of the capitation policy on Cesarean rates in public hospitals in Ghana: an interrupted time series analysis

Summary
Context and objectives. In Ghana, CS rates have increased by
2% since 2014 even though the World Health Organization
has called for the procedure only for medically justifiable
cases. Provider payment mechanisms such as capitation have
been used to moderate CS rates in some settings. We
explored the effects of the withdrawal of the capitation policy
on the Cesarean Surgery (CS) rate in public primary care
hospitals together with vaginal delivery (VD) and antenatal
care for women with 4+ visits (ANC4+) rates. Methods. An
interrupted time-series analytical design was used to assess
the effects of the withdrawal of capitation on selected
variables from the secondary District Health Information
Management System (DHIMS 2) of public hospitals between
January 2015 and December 2019. Results: The results show
that after the policy withdrawal, the trend and level of
provision of CS and VD were not significantly altered.
Significant declining trends of ANC4+ reversed with
significant positive trends after the policy removal.
Conclusion. We conclude that the withdrawal of the
capitation policy may not have impacted the CS rate
significantly in public hospitals. Enhanced capitation
payment mechanisms and specific policies aimed at limiting
CS are needed to curtail the rise in Ghana.