1. IMPROVING ACCESS TO EMERGENCY OBSTETRIC AND PERINATAL CARE IN GHANA
E. Y Kwawukume
Professor and Chair, K.K. Bentsi-Enchill Chair, University of Ghana Medical School, College of Health Sciences, Dept of Obst and Gynae, Korle Bu

2. INTRODUCTION
The main indices of quality obstetric and perinatal care in a given geographical location are maternal and perinatal mortality.
WHO estimates that at least 1,600 women die every day associated with pregnancy and child birth.
90% of these deaths occur in sub-Saharan Africa and Asia.
Annual del KBTH is between 10,000 to 12,000 women.
About 36% of the pregnant women with complications reach the hospital in a moribund state

3. Introduction
40% or more of pregnant women may experience acute obstetric problems during pregnancy, child birth and puerperium.
Of this number an estimated15% of the pregnant women develop life-threatening complications.
Significant percentage of the maternal deaths is therefore due to emergency complications of pregnancy.

4. METHOD Study Population
This is a descriptive study.
Data was collected from published articles including studies from 1984 to 1994 and to 2002,
records were retrieved from the depart of Obs/Gynae and Child Health, KBTH
Ghana Statistical Service, Ministry of Health Human resource Division
University of Ghana Medical School.

5. RESULTS Table 1: Deliveries at Maternity block KBTH 2002-2008
Year Total deliveries Live births Still Births SB/Live births%
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6. Table 2: Maternal Mortality at KBTH
Year Live births Maternal deaths MMR , ,
, ,029 ,
MMR/100,000
Most of the cases are referrals from the district

7. Table3: MM per 100,000 live births
Year Rate      

8. Table 4: Causes of MM at KBTH 1984- 2008
Hemorrhage % %
Hypertensive disorders % %
Abortions % %
Genital infections % %
Obstructed labour % %
Others % %
Causes of MM remain the same but there is significant increase in the major causes, ie hypert and haemorrage

9. Table 5: Perinatal mortality rates per 1,000 births for weights greater than 1,000 grams
Year Rates  
The perinatal mortality rate showed 18.4% decrease as compared to the year 1991.

10. Table 6: Neonatal deaths: Intensive care unit KBTH
Causes Number
 Prematurity
Birth Asphyxia
Bacteria Sepsis

11. Table 7: Causes of perinatal mortality
Causes year /
Prematurity % % % %
Birth asphyxia 26.7% % 23% %
Bacteria sepsis 11.6% % 13% %

12. Table 8: The literacy rate in Ghana. 15yrs and above .
Languages Women Men
English/other languages % %
English/one Ghanaian language 27.2% 41.6%
More than half of the population in Ghana is illiterate.
The literacy rate of women is lower than that of men.

13. Table 9: The population of Ghana projected by sex for 2009 from 2000 census.
Sex Number
Women ,816,192
Men ,600,326
Total ,416,518
The population of women and men is almost equal with the women having a slight edge over the men

14. Table 10: Medical staff projected for 2006 and relationship to population of women
Staff Number % Population Ratio .
Nurses , to 1,000 women
Doctors , to 5,000 women
There is a geographical there are regional variation from the North to the South

15. Table 11: Training of medical students from the UGMS
Year enrolled No Year graduated No graduated
An average of 88 doctors is produced annually since 1999.

16. Table 12: Diploma Training; Ghana College
Year No. Obstetricians No. Pediatricians

17. Table 13: Membership training from the Ghana college
Year Obst Pedia Anes Family Med

18. DISCUSSION
MMR of per 100,000 live births and the perinatal mortality rate of 80.7 per1,000 births are high compared to that obtained in the developed countries.
The causes of maternal and perinatal mortality have remained the same
the major causes of maternal mortality, hemorrhage and hypertensive disorders of pregnancy, showed a significant percentage increase.
These causes are emergency obstetric and perinatal conditions.

19. Factors that impede access to emergency health care delivery.
More than half of the population of Ghana are illiterate .
The illiterate population is less likely to lead a healthy life style.
They are also less likely to make use of available health services.
Clinical features of complications of pregnancy may not be recognized and as such may be misinterpreted and report late for treatment.

20. Factors that impede access to emergency health care delivery.
Poverty is a high risk factor
It is associated with illiteracy and impedes access to health care.
The global economic situation is not in favor of the developing countries.
This situation has been worsened by bad governance; bad developmental policies and corruption
The majority of the population is therefore poor.
When complications arise there may be no money to finance transportation and medical bills.
The patient may not be taken to a health care facility.

21. Delays in reaching a health care facility
Due to physical distance,
Poor road networks,
Inadequate ambulance services.

22. Factors that impede access to health care at the level of health care facility,
lack of medical supplies and equipment,
non functioning theaters
shortage of medical staff.
From the study the ratio of a nurse to the women population is 1:1000
doctor to the women population 1:5000.
This is woefully inadequate leading to MM/PNM.

23. Access to Health Care
Measures presently taken to address the situation are also woefully inadequate.
On the average 88 doctors are trained annually from KBTH
Much more worse is the number of Specialist doctors

24. Reasons for increase in MMR at KBTH
inadequate number of midwives,
lack of functioning theatres
frequent shortages of blood and blood products as against a high annual delivery rate.

25. How can access be improved
To increase the literacy rate at all the levels of education including informal education.
To reach out to the populace on health issues both in English and the local languages.
The transportation network should be improved.
The National Ambulance Service should be resourced and expanded to reach a large number of communities.
Helicopter services should be established to airlift emergency cases to health facilities.

26. How can access be improved
mobile phone services to compliment the services in the transport sector
Governments to tackle the problems of corruption, show good governance and formulate policies when dealing with multinational coorperations in order to get better deals for their countries
National Health Insurance Scheme to be encouraged.
The challenges in the NHIS affecting the finances of the health providers should be quickly addressed.
Health personnel should have continuous heath education including ethics. This is currently being done - Continuous Professional Development Programs for doctors.

27. Problems of delivery in Teaching Hospitals
Efforts must be made to decongest the hospitals
Polyclinics should be fully functional

28. Good News La polyclinic now a hospital.
The burden on KBTH has reduced. Delivery from 12,000 to 9,931 babies annually.
Many standard Private hospitals are springing up
Private organizations are helping government facilities eg MTN refurbishing KBTH labour ward and thaetres.
Private institutions should train more health personnel
They should be encouraged to grow to effectively supplement the efforts of government

29. Neonatal death Major causes are Prematurity and asphyxia
Supervised delivery should be encouraged
Adequate ambu-bags in labour wards and NICU
Availabilty of Maternal and neonatal ventilators
Oxygen cylinders to be at all delivery units
Management protocols should be established.

30. CONCLUSION
Maternal mortality is a Human Rights issue and should be recognized as such

31. Conclusion Doctors and nurses- Are we doing enough!
 What about Hospital Administrators!
What about Parliamentarians!-do you know the needs of pregnant women in your constituency?
And our Ministers- are we visiting health institutions including maternity homes!
What about ourselves who are hearing this presentation

32. Imagine that the first woman had died from Pregnancy or delivery, what would have become of the world

33. Ladies and Gentlemen let us be more proactive towards the needs of those who deliver the most important human beings on earth “our makers on earth!”

34. Thank you