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Transcript of Maternal Health in Ghana challenges and Strategies, Miklin Hotel Family Health Division, Ghana...
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