Improve maternal health
Though maternal health care has improved over the past 20 years, the pace has been slow and extra effort is required for Ghana to achieve the MDG 5 target of reducing maternal mortality rate by three quarters by 2015. Institutional maternal mortality rate has reduced from 216 per 100,000 live births in 1990 to 164 per 100,000 live births in 2010 with a distance of 110 to target of 54 per 100,000 in 2015. The full implementation of the recently developed MDG Acceleration Framework (MAF) gives hope that MMR will further reduce by 2015.
What contributed to the progress?
A number of interventions introduced by government to improve maternal healthcare include
• The implementation of free maternal health services, repositioning family planning and training as well as repositioning reproductive and child health staff;
• A safe motherhood task force is operational and government is supporting increased production of midwives through direct midwifery training. For example, with two new midwifery training schools opened in Tamale and other places, the initiative has resulted in 13 per cent increase in national enrolment between 2007 and 2009. Moreover, in 2010, midwives received specific training on the use of partograph. Knowledge in the use of partograph promotes confidence, reduces prolonged labour, caesarean sections and intrapartum still births;
• The High Impact Rapid Delivery (HIRD) approach is also being implemented as a complementary strategy to reduce maternal and child mortality. Several districts have indicated progress in service indicators achieved and innovative strategies implemented with regard to improving maternal health;
• Other interventions also include Ghana VAST Survival Programme, Prevention of Maternal Mortality Programme (PMMP), and Safe-Motherhood Initiative;
• There are also projects such as Making Pregnancy Safer Initiative, Prevention and Management of Safe Abortion Programme, Maternal and Neonatal Health Programme and Roll Back Malaria Programme, Intermittent Preventive Treatment (IPT); and
• Emergency Obstetric and Neonatal Care (EmONC) is being implemented in all 10 regions, but not yet with full complement of required resources (midwives, equipment).
In order to achieve the MDG of reducing maternal mortality by three-quaters, several challenges and bottlenecks have been identified in maternal health services. These challenges
• Increase in scaling up maternal health services, particularly at the district level as well as investments in Community Health Planning Services and related Primary Health Care infrastructure and systems within the context of the Ouagadougou Declaration;
• Improving Deployment of skilled health workers, supply of equipment, logistics, staff accommodation, transportation and ambulance services in addressing human resource constraints and poor quality of care continue;
• Referrals still remain a problem in many districts. Three out of the five districts visited had no ambulance services. Although regional and district hospitals are well equipped to handle complicated labour cases, the main issue is how to timely transport women in labour to these facilities. The national ambulance service is said to be expensive (and probably not yet able to ensure district-based services);
• The NHIS does not cover the cost of conveying women in labour to the facilities. The fact that the additional costs of transporting the women in labour together with the responsible TBA to the nearby hospital or health facility are not covered may be one of the major factors explaining the reluctance of mothers to deliver at the facility;
• Unavailable data set on maternal healthcare for systematic investigation into maternal health and lack of well-structured plans and procedures to check and assess where maternal health programmes are absent;
• Barriers to access to critical health services by families and communities, mainly due to inadequate financial capabilities of families or mothers, long distance to the health facility and low female literacy rate as well as poor health-seeking behaviours among the poor, and socio-cultural factors such as men’s influence in healthcare decision making