A review of the exemption policy at the sub-district level: a case study of Ejisu-Juaben District of Ashanti Region

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Providing exemptions is meant to increase access to healthcare for those who cannot pay. Thus, the main aim of the exemptions is to mitigate the problems of user charges and to ensure equity. The Vulnerable in Society which traditionally includes children, pregnant women, the elderly (70+) and certain diseases of public health importance are exempted from user charges. Since providing exemptions is not free, as someone has to pay for it, it calls for proper management of the funds. This will require knowing how implementers understand and interpret the policy and efforts made by them to achieve objectives for exemptions. The main objective of the study was to assess the effect of the exemption policy at the Ejisu-Juaben District. The study design was retrospective cross-sectional, employing both quantitative and qualitative methods. The sample size was 50 and made up of 42 sampled households and 8 key informants. Results from the study indicated increases in attendance for the Aged and pregnant women over the years. Though children under 5 years were being exempted from consultation fees no claims were being made for reimbursement whilst the other categories, especially, paupers were not being exempted for reasons well known — difficulty in identification. The level of awareness among households was high especially for the aged. However, delays in reimbursement and the amount involved were seriously decapitalizing the drug and non-drug accounts. Recommendations were made to health managers to plan towards utilisation of exemption funds, especially amount per capita on each category and the need to integrate data on exemption into routine data collection system.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi in partial fulfilment of the requirements for the degree of Master of Science in Health Services Planning and Management, 2001