ABSTRACTBackground: Maternal health is challenged with morbidity and mortality in Sub-Sahara Africa (SSA). Interventions to control the incidence of mortality are very crucial. Therefore, implementation of free maternal healthcare is very imperative with regards to curbing maternal morbidity and mortality in SSA where complication before and during delivery is increasingly …
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ABSTRACTBackground: Maternal health is challenged with morbidity and mortality in Sub-Sahara Africa (SSA). Interventions to control the incidence of mortality are very crucial. Therefore, implementation of free maternal healthcare is very imperative with regards to curbing maternal morbidity and mortality in SSA where complication before and during delivery is increasingly high. This study was conducted to map evidence on free maternal healthcare financing and the quality of care in SSA. Methods: We conducted a systematic scoping review with PubMed, Google Scholar, and Science Direct databases and searched literature within SSA. All eligible studies were exported to Mendeley citation manager. Eligibility criteria included articles that documented free maternal healthcare financing from clients, managers and providers’ perspective of quality care in SSA. We employed Population, Content, and Context (PCC) to determine eligible studies from our research questions. Two co-screeners independently reviewed the articles for eligibility. The following themes were extracted from the included studies: clients’ perspective of quality of maternal healthcare policy, managers' and providers’ perspective, types of free maternal healthcare financing and sources of finance in SSA. We used mixed methods appraisal tool (MMAT) – version 2011 to assess the risk of bias for the included studies.Results: In general, the study findings presented evidence on the implementation of free maternal healthcare and quality of care in Sub-Sahara Africa (SSA). The evidence further showed that few countries in SSA had literature on free maternal healthcare and quality of care. The following countries: Burkina Faso, Burundi, Ghana, Kenya, Niger, Nigeria, Sierra Leone, Tanzania and Uganda, were shown to have evidence on free maternal healthcare and quality of care as an intervention for maternal death in SSA. Despite evidence of free maternal healthcare and quality of care found in the small segment of the study population, all the stakeholders (clients, managers and providers) rated the quality of care as low from their perspective. Therefore, continual evaluation and monitoring of the quality of care in the maternal healthcare policy is necessary in SSA. Although free maternal healthcare financing intervention is adopted in some parts of SSA, there is a disregard for the quality of service rendered to clients.Conclusion: Free maternal healthcare policy has been shown to provide access to healthcare by pro-poor and indigents. The study finding demonstrated high utilization of maternal care in most of the included studies even though service was rated as poor. Again, the study proved that overcrowding exists in SSA countries where the policy is practiced. Therefore, intervention to improve the quality of free maternal healthcare is necessary.Keywords: Maternal healthcare, health financing, free maternal healthcare, quality of care, Sub-Sahara Africa.
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