Abstract
BackgroundThe burden of maternal mortality in sub-Saharan Africa is very high. In Ghana maternal mortality ratio was 380 deaths per 100,000 live births in 2013. Skilled birth attendance has been shown to reduce maternal mortality and morbidity, yet in 2010 only 68 percent of mothers in Ghana gave birth with the assistance of skilled birth attendants. In 2005, the Ghana Health Service piloted a strategy that involved using the integrated Community-based Health Planning and Services (CHPS) program and training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). The study assesses the feasibility of and extent to which the skilled delivery program has been implemented as an integrated component of the existing CHPS, and documents the benefits and challenges of the integrated program.MethodsWe employed an intrinsic case study design with a qualitative methodology. We conducted 41 in-depth interviews with health professionals and community stakeholders. We used a purposive sampling technique to identify and interview our respondents.ResultsThe CHO-midwives provide integrated services that include skilled delivery in CHPS zones. The midwives collaborate with District Assemblies, Non-Governmental Organizations (NGOs) and communities to offer skilled delivery services in rural communities. They refer pregnant women with complications to district hospitals and health centers for care, and there has been observed improvement in the referral system. Stakeholders reported community members’ access to skilled attendants at birth, health education, antenatal attendance and postnatal care in rural communities. The CHO-midwives are provided with financial and non-financial incentives to motivate them for optimal work performance. The primary challenges that remain include inadequate numbers of CHO-midwives, insufficient transportation, and infrastructure weaknesses.ConclusionsOur study demonstrates that CHOs can successfully be trained as midwives and deployed to provide skilled delivery services at the doorsteps of rural households. The integration of the skilled delivery program with the CHPS program appears to be an effective model for improving access to skilled birth attendance in rural communities of the UER of Ghana.
Highlights
The burden of maternal mortality in sub-Saharan Africa is very high
Community Health Officers (CHOs)-midwives deliver ‘integrated services’ The CHO-midwives report engagement in a wide range of services, including antenatal care, skilled delivery and postnatal care, health education, counseling, family planning services, child welfare clinics for nursing mothers, treatment of minor ailments, community durbars and other ‘outreach’ activities. They collaboratively provide these services with other nurses, community members, District Assemblies and Non-Governmental Organizations (NGOs) workers; community leaders confirmed a range of services the CHO-midwives and other professionals provide in their rural communities
Health education According to the CHO-midwives, the health education is usually focused on a wide range of topics such as skilled delivery, antenatal and postnatal care, disease prevention, environmental cleanliness, personal hygiene, nutrition and medication
Summary
The burden of maternal mortality in sub-Saharan Africa is very high. In Ghana maternal mortality ratio was 380 deaths per 100,000 live births in 2013. The global burden of maternal death is enormous, especially in less developed countries [1]. 56 percent of global maternal deaths occur in sub-Saharan Africa. Ghana is among the countries in sub-Saharan Africa with the highest overall maternal mortality ratios (MMR) at 380 deaths per 100,000 live births in 2013 [2]. Among them, improved family planning, safe abortion or adequate post-abortion care, improved coverage and quality of skilled attendance at birth, and access to emergency obstetric care to address maternal mortality [3,4]. Experts agree that access to skilled attendants at birth is a key component for nations committed to preventing maternal deaths; the proportion of births with skilled attendants is one of the key indicators for monitoring progress towards the achievement of Millennium Development Goal (MDG) 5 [3,4]
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