Feature by Yaw Ansah
Accra, February 15, - Three years
ago, Ministry of Health and Ghana Health Service in collaboration with
development partners put together an initiative called the Millennium
Development Goals Acceleration Framework (MAF).
It was to re-double efforts to
overcome bottlenecks in implementing interventions that had proven to work in
reducing the maternal mortality ratio in Ghana.
The MAF focuses on improving
maternal health at the level of both community and healthcare facilities
through the use of evidence-based, feasible and cost-effective interventions in
order to achieve an accelerated reduction in maternal and new-born deaths.
Ghana Health Service, Teaching
Hospitals, Christian Health Association of Ghana (CHAG), Ambulance Service,
Health Training Institutions and other implementing partners of the Ministry of
Health received funding to implement various activities to ensure that for
Ghana to achieve the Millennium Development Goal 5 target of reducing the
maternal mortality rate by three quarters.
CHAG networks Approach
Realising that institutional
maternal mortality occurred under different circumstances in various communities
and the urgent need to reduce the rate of the phenomenal CHAG formed a team of
five in each of the hospitals, 75 within its networks to find out the causes of
institutional maternal mortality, number of deaths occurring every year, as
well as calculated the interval of deaths that occurred.
Dr James Duah, Deputy Executive
Director of CHAG in an interview the GNA said, “There were varied causes for
the various institutions; while some hospitals were recording deaths
frequently, other facilities recorded death cases sparingly. We then wove all
our approaches towards ensuring that we travel 100 days without recording
maternal death”.
As part of the strategies, Dr
Duah recalled that the various institutions under CHAG were grouped into four
zones, and for each zone, each hospital identified causes of maternal deaths
and consequently put together ideas on how to address the challenges that
brought the deaths.
“Each team designed a plan based
on the causes and suggested interventions. Within our network, we assigned 23
obstetricians and gynaecologist to visit various facilities within 100 days to
look at what the teams do and to offer assistance in all forms including
training”
“After each 100-day period, all
the team members from the hospital and the obstetricians and gynaecologist meet
and assess the targets – successes and challenges, that each facility
encountered. Members briefed the team if they recorded maternal deaths, what
happened and if no death was recorded, what was the success stories that can be
built on”, he said.
Dr Duah who led the
implementation of the strategy with 5-member committee said other additional
approaches to achieve the target was the establishment of a collaborative
networking among the members of the zones, instituted a mentorship programme
and also used social media.
Various field training involving
the use of mentors, who were obstetrician/ gynaecologists and midwives for
practical on-site training were conducted in the area of in family planning,
obstetric surgeries, Life-Saving Skills (LSS), Essential New Born Care (ENBC),
CTG and Ultrasound Scan.
Recognising that work cannot be
carried out without appropriate tools, CHAG obtained essential equipment for
EmONC, including; cardiotocograph (CTG) machines, electronic Foetal Doppler
machines and ventilation/ ambu-bags for all its facilities.
Innovative approaches
Under the mentorship programme,
hospital teams were assigned to obstetrician/gynaecologists and midwives
(mentors) with the aim of improving maternal and foetal outcomes.
Achievements
During the first 100 days of the
free maternal mortality campaign, 83.3 per cent of all the CHAG hospitals
recorded no maternal mortality. Institutional Maternal mortality ratio reduced
from 230/100,000 live births in the first quarter when the programme was
introduced, to 135/100,000 live births in the fourth quarter.
Year on year, there was a
reduction from 145 per 100,000 live births in 2015 to 109 per 100,000 live
births at the end of 2016. Artificial
Family planning acceptor rates (specifically implant insertion) increased from
65 per 1,000 in 2015 to 205 per 1,000 PNC registrants in 2016.
A total of 284 facilities were
given tools including; ventilation bags for emergency obstetric and neonatal
care. 34 hospitals were given electronic foetal Doppler machines, while
fifty-two (52) facilities were given CTG machines. This equipment in no small
way contributed to the reduction in maternal and neonatal mortality rates.
The initiative saw health
officials receiving hands-on training on the use of equipment as well as health
procedures.
Dr Duah recalled that about 51
doctors were trained in obstetric surgeries, 292 midwives; staff nurses,
doctors and community health nurses had tuition in life-saving skills.
In addition, 301 Midwives and
Staff Nurses were trained in ENBC including; kangaroo mother care, 104 Midwives
and staff nurses were trained in an obstetric ultrasound scan and CTG machines,
as well as 58 Health workers, were schooled in maternal health and death audit.
Through these innovations, about
355 health professionals had access to knowledge and skills to help manage
difficult maternal health issues and about 71 hospital teams were mentored by
obstetrician / gynaecologists and midwives.
Conclusion
Mr Peter Yeboah, Chief Executive
Officer CHAG told GNA that the MAF programme has allowed CHAG to build the
capacity of various categories of its workers in priority areas for emergency
obstetric and neonatal care, which include; obstetric surgeries, ultrasound
scan, essential new-born care and life-saving skills. Health facilities within
the network have acquired basic equipment necessary for emergency obstetric and
neonatal care.
He said, the programme also allowed
the development of innovative approaches to solve maternal death problems with
the social media platform/technology for health and the collaborative meetings.
The rank and file of the member institutions have embraced the 100-days free of
maternal death concept.
Recommendations
Mr Yeboah recommended that the
MAF initiatives, which enabled the institution to come out with the 100-days
free of maternal mortality campaign need to continue in order to sustain the
gains made within the CHAG network regarding maternal mortality.
The Executive Director believes
that lesson learnt from the MAF programme indicated that it was possible to
achieve zero maternal mortality if the principles of responsive voluntary
accountability mechanisms are institutionalised.
“Support visits through the
mentorship programme is a great way to reduce maternal mortality. For that
matter, efforts should be made to secure funding to maintain these visits
beyond the MAF programme. It is a great way to share the skills and knowledge of
the few specialists within the network,” he added.
GNA
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