Do Health Policies Reduce Maternal and Child Mortality in Ghana? Evidence from a Difference-in-Differences Analysis
- 1Virginia Tech
Abstract
Ghana introduced a sequence of health policies between 1999 and 2019 to accelerate reductions in maternal and child mortality, including the Community-Based Health Planning and Services initiative, the National Health Insurance Scheme, a Free Maternal Care policy, the Ghana Essential Health Interventions Program, and the National Newborn Health Strategy. Prior evaluations have relied on descriptive trend analysis and cross-sectional comparisons, without constructing a credible counterfactual. This paper applies a staggered 2x2 Difference-in-Difference approach to estimate the causal effect of each policy on annual mortality outcomes over the period 1990 to 2023, comparing Ghanas trajectory against the global average and the lower-middle-income country group as comparators. Parallel trends are assessed through event-study plots of annual treatment effects. For child mortality, GEHIP (2012) reduced mortality by an estimated 9.5 percent relative to the global trend, and NNHS (2019) by 16.4 percent, though mild pre-existing drift in the NNHS window means the latter is an upper bound. For maternal mortality, GEHIP again produces the most credible estimate at 7.2 percent below the global comparator, supported by a near-flat pre-period ATT series. The Free Maternal Care policy (2008) produced no detectable improvement in maternal mortality relative to either comparator, consistent with evidence that access reforms require adequate facility capacity to translate increased attendance into reduced mortality. CHPS (1999) generates a large apparent maternal mortality effect that is invalidated by a strong pre-existing downward trend in the event-study window. Taken together, the results indicate that supply-side and quality-focused interventions have driven Ghanas most credible mortality improvements, while financial access reforms have had their strongest effects on child rather than maternal survival.
Related
- Impact evaluation of Lean Healthcare in emergency departments: evidence from a large-scale Brazilian initiative using difference-in-differences
- Effect of the WHO Labour Care Guide Implementation on Maternal and Newborn Outcomes in Selected Referral Hospitals of Zambia: A Difference-in-Differences Analysis
- Regional inequalities in maternal-level under-five mortality in Ethiopia: evidence from the 2019 Mini-DHS using multilevel negative binomial and Bayesian models.
- Evidence synthesis on sex differences in mortality after traumatic brain injury: Systematic review integrating meta-analysis and explainable machine learning
- Cannabis legalisation and cardiovascular hospitalisations in the United States: nationwide difference-in-differences analysis, 2012–2018
BibTeX
@misc{tome2026health,
title = {{Do Health Policies Reduce Maternal and Child Mortality in Ghana? Evidence from a Difference-in-Differences Analysis}},
author = {M. Tome and G. Ayettey},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.22.26366200},
url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366200v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Do Health Policies Reduce Maternal and Child Mortality in Ghana? Evidence from a Difference-in-Differences Analysis
AU - M. Tome
AU - G. Ayettey
PY - 2026
DA - 2026/10/22
PB - medRxiv
DO - 10.64898/2026.10.22.26366200
UR - https://www.medrxiv.org/content/10.64898/2026.10.22.26366200v1
AB - Ghana introduced a sequence of health policies between 1999 and 2019 to accelerate reductions in maternal and child mortality, including the Community-Based Health Planning and Services initiative, the National Health Insurance Scheme, a Free Maternal Care policy, the Ghana Essential Health Interventions Program, and the National Newborn Health Strategy. Prior evaluations have relied on descriptive trend analysis and cross-sectional comparisons, without constructing a credible counterfactual. This paper applies a staggered 2x2 Difference-in-Difference approach to estimate the causal effect of each policy on annual mortality outcomes over the period 1990 to 2023, comparing Ghanas trajectory against the global average and the lower-middle-income country group as comparators. Parallel trends are assessed through event-study plots of annual treatment effects. For child mortality, GEHIP (2012) reduced mortality by an estimated 9.5 percent relative to the global trend, and NNHS (2019) by 16.4 percent, though mild pre-existing drift in the NNHS window means the latter is an upper bound. For maternal mortality, GEHIP again produces the most credible estimate at 7.2 percent below the global comparator, supported by a near-flat pre-period ATT series. The Free Maternal Care policy (2008) produced no detectable improvement in maternal mortality relative to either comparator, consistent with evidence that access reforms require adequate facility capacity to translate increased attendance into reduced mortality. CHPS (1999) generates a large apparent maternal mortality effect that is invalidated by a strong pre-existing downward trend in the event-study window. Taken together, the results indicate that supply-side and quality-focused interventions have driven Ghanas most credible mortality improvements, while financial access reforms have had their strongest effects on child rather than maternal survival.
ER -