Maternal Health in Ghana challenges 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 3 rd Delay Delay in receiving care at the health facility 1 st Delay Delay in the Home 2 nd 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?

Current Situation

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

Trends in Contraceptive Use Percent of currently married women

Unmet need for Contraception

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

Fertility

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 Causes of Maternal Deaths (Verbal Autopsy) GSS/GHS/ICF Macro Percentage of deaths to women age 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 skills  Many 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

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

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 Planning 2. Skilled Delivery 3. Emergency Obstetric and Newborn Care 4. Crosscutting or Health Systems issues The Seoul Post Conference: Implementation and Implications 7th October MDG Accelerated Framework (MAF)

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 23

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.

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