Can community health officer-midwives effectively integrate skilled birth attendance in the community-based health planning and services program in rural Ghana?

Reproductive Health

Henry V Doctor³  Samuel Mills⁵  Kojo Yeboah-Antwi¹  Judith Bernstein²  Lois McCloskey²  Evelyn Sakeah⁴ 

[1] Department of Global Health, Boston University School of Public Health, Boston, MA, USA;Department of Community Sciences, Boston University School of Public Health, Boston, MA, USA;Integrated Programme and Oversight Branch, Division for Operations, United Nations Office on Drugs and Crime, Abuja, Nigeria;Social Science Unit, Navrongo Health Research Centre, Upper East Region, Navrongo, Ghana;Health, Nutrition, and Population, Human Development Network, The World Bank, Washington, DC, USA

关键词: Skilled birth attendance;    Maternal mortality;    Ghana;    Community-based service delivery;   

Others  :  1131953
DOI  :  10.1186/1742-4755-11-90

 received in 2014-01-03, accepted in 2014-12-11,  发布年份 2014

【 摘 要 】

Background

The burden of maternal mortality in sub-Saharan Africa is very high. In Ghana maternal mortality ratio was 380 deaths per 100,000 live births in 2013. Skilled birth attendance has been shown to reduce maternal mortality and morbidity, yet in 2010 only 68 percent of mothers in Ghana gave birth with the assistance of skilled birth attendants. In 2005, the Ghana Health Service piloted a strategy that involved using the integrated Community-based Health Planning and Services (CHPS) program and training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). The study assesses the feasibility of and extent to which the skilled delivery program has been implemented as an integrated component of the existing CHPS, and documents the benefits and challenges of the integrated program.

Methods

We employed an intrinsic case study design with a qualitative methodology. We conducted 41 in-depth interviews with health professionals and community stakeholders. We used a purposive sampling technique to identify and interview our respondents.

Results

The CHO-midwives provide integrated services that include skilled delivery in CHPS zones. The midwives collaborate with District Assemblies, Non-Governmental Organizations (NGOs) and communities to offer skilled delivery services in rural communities. They refer pregnant women with complications to district hospitals and health centers for care, and there has been observed improvement in the referral system. Stakeholders reported community members’ access to skilled attendants at birth, health education, antenatal attendance and postnatal care in rural communities. The CHO-midwives are provided with financial and non-financial incentives to motivate them for optimal work performance. The primary challenges that remain include inadequate numbers of CHO-midwives, insufficient transportation, and infrastructure weaknesses.

Conclusions

Our study demonstrates that CHOs can successfully be trained as midwives and deployed to provide skilled delivery services at the doorsteps of rural households. The integration of the skilled delivery program with the CHPS program appears to be an effective model for improving access to skilled birth attendance in rural communities of the UER of Ghana.

【 授权许可】

   
2014 Sakeah et al.; licensee BioMed Central.

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