Maternal Health in Ghanachallenges and Strategies, Miklin Hotel

Family Health Division, Ghana Health Service

2 April, 2014

Introduction 1

Guiding Principles Maternal Health refers to the health of women

during Pregnancy, Child Birth and the Post Partum period.

Maternal Health is a human rights issue – No woman should Die giving Life

Level of maternal mortality is a key measure for a Nations Development and resources and how Equitable those resources are distributed

Introduction 2

Guiding Principles Maternal health is not only a clinical matter; social,

cultural and economic dimensions are equally important

Promoting maternal health has become a development challenge. how to bring synergy across sectors (e.g. education, finance health and ministries responsible for infrastructure) to propel collaborative and acceleration actions

Delivering on maternal health Goal is beyond what the Government can do alone, collaboration with other stakeholders is critical.

Introduction 3

Key determinants includes Adult female literacy Access to FP services Health systems capacity (Mirrors

development), Geographical and financial access to health, Referral Systems etc.

The Three Delays Leading to Maternal and Newborn Death

3rd Delay

Delay in receiving care at the health facility

1st Delay

Delay in the Home

2nd Delay

Delay in Accessing the Health Facility

unaware of the need for care,

unaware of the warning signs of problems in pregnancy?

services do not exist, or are inaccessible for other reasons, such as distance, cost or socio-cultural barriers?

–care they receive is inadequate , delayed and may actually be harmful?

0

40

80

12082

40

86

58.944

89

62.344

9269.4

47

9578.2

58.7

96.784.7

68.4

Maternal Care Indicators

GDHS 1988 GDHS 1993 GDHS 1998GDHS 2003 GDHS 2008 MICS 2011

Per

Cent

Current Situation

The richer, educated and urban residents benefiting more from skilled deliveries…

RuralUrban

RESIDENCE

NonePrimary

Middle/JSSSecondary +

MOTHER EDUCATION

PoorestSecondMiddleFourth

RichestWEALTH QUINTILE

NATIONAL

.0 20.0 40.0 60.0 80.0 100.0 120.0

53.988.2

54.566.2

79.498.1

40.255.0

70.286.0

98.3

68.4

Trends in Contraceptive Use

13

58

20

10 10

22

13

9

25

19

7

24

17

7

33

23

9

Any method Any modern method Any traditional method

1988 1993 1998 2003 2008 2011

Percent of currently married women

Unmet need for Contraception

Wes

tern

Centra

l

Great

er A

ccra

Volta

East

ern

Asant

e

Brong

Aha

fo

North

ern

Upper

Eas

t

Upper

Wes

t

Tota

l 200

8

Tota

l 201

1.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

25.1 22.619.7

37.9

22.4

29.8 27.330.4

26.3 28.0

35.3

26.4

Unmet need for Contraception

Click icon to add picture

CYP FOR 2013 IS PROJECTED TO REACH 2,400,000

Fertility

1990 1996 2000 2007 2008 2015

740

590540

451

350

185

Trends in Maternal Mortality Ratio in Ghana and MDG Target

Maternal Mortality

In the current WHO/UNFPA/WORLD BANK TRENDS IN MMR REPORT 2008 GHANA‘S MMR IS 350/100,000 LB AND CLASSIFIED AS MAKING PROGRESS AND MMR REDUCED 42% FROM THE 1990’S- Represents 2,600 maternal Deaths a year

CAUSES OF MATERNAL DEATH

All Cause-specific Mortality

Maternal; 14

Infectious disease; 41

Malignancy; 6

Circulatory disease; 12

Transport ac-cidents; 2

Other external causes; 3

Diseases of nervous system, digestive, respi-

ratory; 12

Other causes, classi-fied; 11

Causes of Maternal Deaths(Verbal Autopsy)

GSS/GHS/ICF Macro

Percentage of deaths to women age 15-49 in the five years preceding the survey

KEY ISSUES AND HEALTH SYSTEMS CHALLENGES

KEY ISSUES: Socio economic

Low risk perception and under utilisation of existing services

Harmful traditional practice affecting maternal and infant health

HUMAN RESOURCE AND EMONC

Human resource numbers and skillsMany one man stations

I Doctor in District hosp Lonely midwife in HC

4,000 midwives needed Inadequate access to Emergency Obstetric and

Newborn Care Absence of Essential Newborn care program

Poor Access to EmONC

Referral

Weak referral systems and services –

poor roads, lack of transport inadequate communications Heavy traffic in big cities has become a

challenge despite adequate geographic access to health care

Infrastructure

Elec

tricity

Sour

ce o

f wat

er

Cell P

hone

s

Incine

rato

r

98 99 92

58

8392 85

30

93 9881

36

HospitalsHealth CentersMat Homes

KEY STRATEGIES

Response has been grouped in 5 key areas Scaling up of cost effective high impact

interventions Innovation and Accountability/Governance Advocacy (AWLN, PPAG others) Health system strengthening Resource Mobilisation

Governance and Accountability Systems

Ghana has a fairly robust system of monitoring the health sector plan from the national to the district level

National level- Annual Independent reviews Health Summits (April and November) – aide memoire Sector partners meeting Monthly Business meeting Health Sector, DP, CSOs and Private sector

Inter Agency Committee on Contraceptive Security Regional /District– Performance reviews – DPs Local NGOs /CSO and

community leaders and the Health Committees

National health Account and RH sub account Resource tracking for maternal health services

The Seoul Post - 2015 Conference: Implementation and Implications 7th October 2013

22

MAF has three priority areas and one cross-cutting are:The MAF focuses on improving maternal health at both community and health care facility levels through the use of evidence-based, feasible and cost effective interventions in order to achieve accelerated reduction in maternal and new born deaths.

1. Family Planning2. Skilled Delivery 3. Emergency Obstetric and Newborn Care4. Crosscutting or Health Systems issues

MDG Accelerated Framework (MAF)

23

Advocacy (outcomes) Maternal mortality an important political issue The President of Ghana is currently

Championing Maternal Health and FP 10% of salaries of Govt appointees donated to

reduce MM Maintenance of Free maternal health Service

by incorporating it in the new Health Insurance Law

Free family planning services as part of the NHIS

Task shifting - FP service policy reviewed to allow auxiliary nurses provide contraceptive implant services to improve access to services

Local Govts to be appraised using Maternal mortality

Innovations

M-Health MOTECH, EWS Emergency response Data capture with smart phones National call center project ongoing

Increased Production/Deployment of Midwives

• Establishment of Direct Diploma midwifery courses

• Re-introduction of the Enrolled Midwifery training program

• Expansion of number and enrollment into Pre service institutions- midwifery training schools

• Contracts for retiring MW• Enrollment increased gradually

from 378 per year in 2006 to 800 in 2010 and 1,300 in 2012

Infrastructure and Equipment

Upgrading of Health Centers to Hospitals to improve access to EmONC

Re Tooling and equipping Health Facilities

CONCLUSION

Ghana continues to make steady progress to achieving MDG’s 4 and 5.

Skilled attendant at birth is rising access to and utilization of modern contraceptive methods

is increasing However, the current rate of decline of Maternal Mortality

will not lead the country to achieving the MDG goal 5 unless additional measures are introduced.

The key challenges remain; Poor infrastructure Inadequate human resource Poor access to emergency obstetric care Persistence of cultural and social practises that affect appropriate

health seeking behaviour.

THANK YOU FOR YOUR ATTENTION