The Unofficial Fees of Free Maternal Care: 40% Gaps and 100 Maternal Deaths in Ghana
By Alex Ababio
TAMALE, Northern Region — The slogan is everywhere in Ghana’s clinics and hospitals: “Free Maternal Care.” It is painted boldly on posters, pinned to walls, and written into health policy.
For Aisha Mohammed, a 28-year-old pregnant woman from a small village near Tamale, those words were not just paint on paper. They were a promise—safety, care, and life. But the promise betrayed her.
Aisha’s life ended not in safety, but on a blood-soaked mattress at Tamale Teaching Hospital (TTH). She died of postpartum hemorrhage, heavy bleeding after childbirth. The drug that could have saved her—oxytocin—was missing from the shelves.
The cost of her so-called free care? Her life. Her newborn daughter now lives with the price of that empty promise: a motherless childhood.
Aisha’s story is not rare. Data from the Northern Regional Health Directorate, obtained by Ghanaian Watch, paints a shocking picture. Maternal deaths in the region jumped from 69 in 2022 to 100 in just the first nine months of 2024.
This is no accident. It is a man-made disaster, born from what experts describe as a “40% gap” between what the government promises and what women actually get. It is worsened by a silent culture of corruption that feeds on the poor.
The Ghost of “Free” Care
The road to tragedy usually begins with a quiet demand: “Bring money.”
Rahinatu Alhassan, a 19-year-old first-time mother from Sagnarigu, remembers her “free” antenatal visit.
“The nurse was nice, but she said I had to buy my own gloves. She said they had none,” Rahinatu recalls, holding her one-month-old son. “It cost 15 cedis. Then for the blood test, they said I must pay 10 cedis for the syringe. My husband had to sell two of our chickens to pay for it. What is free? Nothing is free here.
Hidden Costs of “Free” Maternal Care
Gloves: 15 cedis
Syringe for blood test: 10 cedis
Out-of-pocket payments reported: 97% of mothers (BMJ Global Health 2023)
Non-medical items like gloves, syringes, transport: 58% of total cost
Her story is not an exception. It is the rule.
Dr. Abena Ofori, a health economist at the University of Ghana, is blunt:
“The term ‘informal corruption’ is too sanitized. What we have is a predatory coping mechanism. The NHIS pays facilities late and not enough. So the cost is quietly shifted to the poorest pregnant women. It is a deadly tax.”
The Empty Cabinet and the 40% Gap
The crisis grows in hospital storerooms. At TTH’s maternity ward, a midwife (name withheld for safety) opened a cabinet for this reporter. It was almost empty.
“See for yourself,” she said, pointing at the bare shelves. “Where is the oxytocin? Where are the ergometrine injections? We have maybe two or three doses for the whole week with dozens of deliveries. We are forced to choose: which mother gets the last dose? The one bleeding now, or the one who may bleed tomorrow?”
The “40% Gap” in Ghana’s Health Supply Chain
Government promises 100% supply
Only 60% actually reaches clinics
Millions of cedis’ worth of undelivered drugs flagged in 2023 Auditor-General’s Report
The emptiness is the “40% gap.” It is the hole between what the central government says it supplies and what actually reaches the clinics.
Emmanuel Dogbe, from Ghana Integrity Initiative, does not mince words:
“The gap is not a mystery. It is a failure of accountability. Funds are released, contracts are signed, but the lifesaving goods vanish between Accra and Tamale. The system is bleeding out—and so are the mothers.”
A Cycle of Debt and Despair
The financial burden crushes families already living on the edge.
The BMJ study revealed that in 32% of households, the hidden costs of maternal care ate up over 10% of their yearly income.
Families are forced into impossible sacrifices—selling livestock, pulling children out of school, or sinking into debt.
Alidu Mohammed, a farmer from Tolon, remembers his nightmare.
“I took a loan from a susu collector—10,000 cedis—to pay for my wife’s care. I am still paying it back two years later. They said it was for ‘motivation’ for the nurses and to buy drugs. What choice did I have? What is the life of your wife worth?”
The Debt Trap of Maternal Care
32% of households spend over 10% of annual income on hidden fees
Families forced to sell livestock or borrow at high interest
Some women delay care or turn to unskilled birth attendants
Fearing these costs, many women delay going to hospital. Some turn to untrained traditional birth attendants, which multiplies their risk of death. The cycle spins on: fear, delay, danger, death.
Sparks of Resistance
But the silence is cracking. Civil groups are pushing back.
In the Northern Region, NORSAAC (Northern Sector Action on Awareness Center) is training “maternal health champions.” These local volunteers educate women about their rights and track illegal charges.
Zaliha Mohammed, a champion in Kumbungu, explains their work:
“We tell women: always ask for receipts. When they ask you to pay for gloves, demand to see the NHIS policy. Their silence is what gives power to this corruption. We must break the silence.”
The Way Forward: Ruthless Accountability
Experts insist the answer is not another glossy policy document. Ghana already has policies. What is missing is accountability.
1. Timely NHIS Payments
The NHIS must pay hospitals directly and quickly, based on clear performance records.
2. Transparent Supply Chain
Deliveries of drugs and equipment must be digitized and trackable—from the national warehouse in Accra down to the smallest clinic in Kumbungu. Citizens should be able to see where the supplies go.
3. A Hotline for Justice
The Ministry of Health must create a toll-free hotline where mothers can report illegal fees. Every report must trigger an investigation.
A Promise Betrayed
Aisha Mohammed is gone. But her story remains as sharp as broken glass in Ghana’s conscience. The 100 deaths in Northern Ghana in 2024 are not just statistics. They are judgments—a verdict that the system has failed its mothers.
“Free maternal care” exists only on posters. On the ground, the care comes with price tags—chickens sold, children pulled from school, loans taken, and sometimes, lives lost.
The policy is a ghost. The bills are real. And the bodies—tragically, devastatingly—are also real.