Evaluation of safe motherhood services in Nkwanta District, Volta Region, Ghana

In Ghana, maternal and infant deaths still represent an important proportion of the burden of mortality. The Ghana Health Service of the Ministry of Health launched a national Safe Motherhood programme to reduce maternal morbidity and mortality. In the Nkwanta district, there has been a reported increase in skilled delivery rate, family planning services in terms of utilization, ANC coverage rate, and a reduction of MMR. In spite of all these achievements of the District and the fact that the safe motherhood program in the Nkwanta district has been operational for the last eight to ten years, it has not been fully evaluated. Factors for the success or otherwise of these programs have not been fully elucidated. it is in this light that this study seeks to evaluate some of the components of the safe motherhood program in the Nkwanta district. This evaluation was conducted to assess the current situation of maternal and neonatal care (delivery and organisation of services, quality of care) and to identify the major components of a future national plan for maternal and parental care. Methodology: The survey was carried out using some of the methods and tools( after adaptation) described in the “Safe Motherhood Needs Assessment” manual produced by WHO in two maternity hospitals, two health centres and six Community health centres of Nkwanta district in the Volta Region, Ghana. Findings: In Nkwanta district, many of the facilities labeled as providing basic essential obstetric care do not provide all the services that qualify them to be labeled as such. This may be due to the observed lack of essential equipments or inadequate training of the staff to provide those services. The skilled attendant per population was much lower than recommended and facilitative supervision of these care providers including the TBA was found to be insufficient. Guidelines for the management of maternal health conditions were not available at the facilities. The district however has an intra-district ambulance system which does not include the mission hospital in the district capital. Conclusion: The quality of care is consequently inadequate, because the health workers especially the midwives do not seem to be sufficiently empowered and valued, lack a clear definition of tasks, appear to lack the necessary skills and sufficient practical experience and are unable to practice them in a reasonable number of clients. Recommendations: Quality of care should be improved through simple and cost- effective interventions and better use of essential drugs. It should also include hands-on training (stressing the use of the partographs and hygienic practices) and sufficient practice to maintain in particular the life-saving skills acquired. Evidence-based guidelines needed for this purpose should be carved out from the national one by the DHMT with the DHMT being responsible for its dissemination and use Capacity to offer basic essential obstetric care should be built by periodic training of staff and regionalization of obstetric and parental services. Essential equipment and supplies e.g. blood pressure apparatus, stethoscope should be made available. The referral and communication system should be improved to involve all health facilities. If possible, and unless referral is considered necessary, the same midwife or group of midwives should take care of a woman from the onset of pregnancy to delivery and postpartum period.

Source: KNUST