Abstract
BackgroundIn Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery. The Ghana Health Service piloted a strategy that involved training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). CHO-midwives collaborated with community members to provide skilled delivery services in rural areas. This paper presents findings from a study designed to assess the extent to which community residents and leaders participated in the skilled delivery program and the specific roles they played in its implementation and effectiveness.MethodsWe employed an intrinsic case study design with a qualitative methodology. We conducted 29 in-depth interviews with health professionals and community stakeholders. We used a random sampling technique to select the CHO-midwives in three Community-based Health Planning and Services (CHPS) zones for the interviews and a purposive sampling technique to identify and interview District Directors of Health Services from the three districts, the Regional Coordinator of the CHPS program and community stakeholders.ResultsCommunity members play a significant role in promoting skilled delivery care in CHPS zones in Ghana. We found that community health volunteers and traditional birth attendants (TBAs) helped to provide health education on skilled delivery care, and they also referred or accompanied their clients for skilled attendants at birth. The political authorities, traditional leaders, and community members provide resources to promote the skilled delivery program. Both volunteers and TBAs are given financial and non-financial incentives for referring their clients for skilled delivery. However, inadequate transportation, infrequent supply of drugs, attitude of nurses remains as challenges, hindering women accessing maternity services in rural areas.ConclusionsMutual collaboration and engagement is possible between health professionals and community members for the skilled delivery program. Community leaders, traditional and political leaders, volunteers, and TBAs have all been instrumental to the success of the CHPS program in the UER, each in their unique way. However, there are problems confronting the program and we have provided recommendations to address these challenges.
Highlights
In Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery
This study examined the extent to which community residents and leaders participated in the skilled delivery program as part of the Community-based Health Planning and Services (CHPS) program, and the specific roles they played in its implementation and effectiveness
We interviewed health professionals (CHO-midwives, District Directors of Health Services and the CHPS Coordinator) to (1) assess the extent to which communities know and use the skilled delivery services, and (2) identify contributions community residents made to the program and to explore successes and challenges of implementing the program
Summary
In Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery. The Ghana Health Service piloted a strategy that involved training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). Recent statistics point to a maternal mortality ratio (MMR) in Ghana of 380 deaths per 100,000 live births This MMR is high when compared with that of other sub-Saharan African countries such as Namibia, which has a MMR of 130 deaths per 100,000 live births but is lower than the subSaharan African regional estimated average of 510 maternal deaths per 100,000 live births [3]. In rural areas of the Upper East Region (UER) which is the focus of this paper, the level is higher (67 percent) than in other rural areas in Ghana [5]
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