MATERNAL AND NEOTENAL CHILD HEALTH
Mother and Child health is since decades among the top priorities of the Ministry of Health of Ghana and the multiple efforts are slowly recording considerable improvements. The mortality rate of children under-5 years of age reduced from 155 deaths per 1’000 live births in 1990 to 60 deaths per 1,000 live births in 2014. Regional data also shows that the deprived northern regions recorded significant reduction: The Upper East Region recorded a 68% reduction from 221.8 deaths per 1’000 live births in 1990 to 72 deaths per 1’000 live births in 2014; whilst the Northern Region recorded a 50% reduction from 221.8 deaths per 1’000 live births to 111 deaths per 1’000 live births. This notwithstanding, Ghana was still short of the 2015 MDG 4 target of 40 deaths per 1,000 live births. The leading causes of under-5 mortality are since year’s malaria (28.1%), Anaemia (6.1%) asphyxia (5.9%) and pneumonia (5.6%), though mostly preventable or treatable diseases.
For the Ministry of Health, one of the biggest concern among the under-5 mortality is the near-stagnant neonatal mortality rate around 32/1’000 live births. Which again is higher in the northern regions of Ghana, where the number increases to 35 (NNSAP, 2013). In Ghana, new-born deaths contribute to 50% of all infants’ deaths. 75% of these babies will die in their first week, and 50% in the first 24 hours. The main causes for new-born mortality are infections (31%), pre-term complications (24%) and intra partum related (27%). Contributing factors are low adoption of family planning methods (25%), high total fertility rate (4.3 children per woman), high adolescent birth rate (60/100 women giving birth are teenagers), low utilization of skilled delivery (68% on average, ranging between 37.3% in Northern region and 89.75 in Greater Accra).
The picture is similar for the national maternal mortality ratio, which fell from 760 deaths per 100,000 live births in 1990 to 319 deaths per 100,000 live births in 2015.The achievements still fell far short of the MDG 5 target of 190 deaths per 100,000 live births, and far from the SDG Goal of 70 deaths per 100’000. This shows that the risk for pregnant women in Ghana is still far too high. The situation is again particularly severe in the Northern Region with an MMR of 207.3 deaths per 100’000 live births in 2016. Haemorrhage (39%) continued to be the leading direct cause of maternal deaths, followed closely by hypertensive disorders (35%), unsafe abortion, obstructed labour/ruptured uterus, ectopic pregnancy and sepsis. The high haemorrhage is attributed to lack of facilities to store blood to facilitate blood transfusion in time of excessive bleeding during labour and or after labour. Also, lack of HB testing facilities in some hospitals, health centres and CHPS compounds leading to women having to seek testing services elsewhere without feedback to the requesting facilities. This makes it very difficult for midwives to know the HB levels of pregnant mothers before/during labour. Additionally, some women are required to make payment for the testing in private laboratories and this has the potential to reduce the number of pregnant women tested at ANC registration. Mothers who deliver at remote facilities are always at danger of losing their lives through bleeding due to the above factors coupled of lack of regular transport system to facilitate referrals.
In Ghana, the SRC in partnership with the GRCS is present in both project regions. In the NR, GRCS is running an eye health project ECS (2005-20) in close partnership with GHS and National Eye Care Unit NECU and in collaboration with Ghana Education Services across the region. The over 10 years’ experience in eye health project delivery with partner organisations gives the niche in quality project management and community health care and community mobilization in the Northern Region. A disaster risk reduction project DRR (2014-17 with new phase 2018-20) is implemented in both NR and UER region in collaboration with Regional and District Directorates of National Disaster Management Organisation (NADMO). The DRR intervention in the NR started earlier and is thus further advanced than in the UER. The actual MNCH is implemented in the UER, (2014-17) which with this new phase (2018-20) will also be expanded to NR. The DRR project started in the UER in some of the existing MNCH communities. Similarly, some of the DRR communities in the NR may differ from the MNCH communities due to possible differences in selection criteria that will be used in selecting beneficiary communities. Through the EHS project, the GRCS is present in the whole of NR and the actual DRR and upcoming MNCH communities in this region will see an overlapping activities with eye health community sensitization and screening activities in some of the communities. Two of the MNCH beneficiary districts (Kpandai and Zabzugu) in the NR do not have DRR intervention.
experiences gained from the MNCH project in UER will guide the MNCH
intervention in the NR and the two regional branches are already collaborating.
The SRC in the recent past supported also a Cholera and Ebola Preparedness
project nationwide and Cerebrospinal Meningitis (Response/Preparedness project)
in the NR and UER. GRCS has gained considerable experience through the two
projects where nationwide collaboration between all branches was crucial and where
thousands of Red Cross volunteers have increased their knowledge in disease
transmission, hygiene, behaviour change, communication strategies and community
mobilization. The interactive radio discussion and social mobilisation
approaches of this MNCH project for example, were influenced by these
experiences and will be adapted to the new project.
Geographical location / map
The upcoming program phase will continue offering MNCH services in the four districts of the Upper East Region covered through the current program (Binduri, Nabdam, Bongo, Kassena-Nankana Municipal), and expand into two additional districts (Pusiga, Talensi). In addition to the two new districts in Upper East, four districts in the Northern Region will be added to the programme (Zabzugu-Tatale, West Gonja, West Mamprusi and Kpandai): The choice of the project districts were made during stakeholders’ meetings, planning meetings and engagement with the health authorities at both regional and district levels in the UER and NR. The Regional Directors of GHS in the two regions and District Directors of the selected districts made strong case for support based on the prevailing needs listed under 3.2 as the reasons for the support. The districts were selected by GHS and GRCS because they were classified as having highest hunger and poverty levels, longest distance travel (intra), worst roads and unreliable transportation systems in accessing health services as well as their susceptibility to natural disasters. As per GRCS strategy/principle, the interventions will continue to target most deprived communities and individuals. The key target groups will be mothers and children with extra emphasis on prenatal, childbirth and postnatal stages to enhance their survival and wellbeing.
In the previous project phase (2014-17), 10 communities were selected in each (4) district for project implementation. The ratio of 10 communities per district will be maintained for the new phase (2018-2020) and implementation will take place in total 120 communities in 10 districts: