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In most Sub-Saharan African countries, a widely adopted policy to increase access to healthcare is the complete or partial removal of health user fees. This paper examines the effect of removing health user fees on the cognitive development of children in Ghana.

The study uses the Ghana Socioeconomic Panel Survey (GSPS) and a difference-in-differences method to analyze the impacts of free healthcare.

The findings show that improved access to healthcare enhances the cognitive ability of children. More importantly, children who received free healthcare in early life experienced significant improvement in their cognitive ability. The benefits are also huge for girls and children from low-income families. The findings further show that maternal health, the timely receipt of vaccinations and regular infant health visits are important operative channels through which improved access to healthcare affects children’s cognitive ability.

There are several studies on the effects of eliminating health user fees on various outcomes, but only a few focus on children’s outcomes. This study contributes to the literature by focusing on a vital child outcome, cognitive ability and exploring the timing and pathways through which abolishing health user fees affect cognitive development in children. Because cognitive ability is crucial for educational and labor market outcomes, the findings are useful for policymakers in determining the population to target and the timing of interventions that yield huge impacts when designing health intervention programs in developing countries.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-11-2022-0739.