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15.05.2018 Opinion

 The Antidote To The Increasing Maternal Mortality Rate In Ghana

By Michael Chiagozie Nwobodo
The Antidote To The Increasing Maternal Mortality Rate In Ghana
15.05.2018 LISTEN

Isn’t it pathetic the rate at which we lose our women to death during labour every year? As you read this now, you might have just remembered your loved one you lost during child delivery. All these would have been prevented if our government and other stakeholders had invested heavily in the health sector in order to improve its functionality (system functioned and was structured properly).

Taking you through the statistics, the Millennium Development Goal 5 target for Maternal Mortality was to help reduce the number of women who die in pregnancy and during childbirth by three-quarters between 1990 and 2015. Applying this target to Ghana, maternal mortality should fall to 145 cases per 100,000 live births. In the period of 2007-2012, Ghana reported a maternal mortality ratio of 450 deaths per 100,000 live births. As of 2015 which was the target time to achieve the set goal of 145 cases, Ghana still recorded about 378 deaths per 100,000 live births. This obviously indicates that Ghana is still far behind in terms of combating maternal mortality rate and this should raise concern for all stakeholders to complement the government’s efforts, so that every Ghanaian can enjoy optimum health.

As of 2017 and even currently, there are still deprived communities in Ghana where inhabitants have to travel as long as two hours on pothole ridden roads, sometimes on tricycles and even on foot to access healthcare; there have even been instances where expectant mothers in labour lose their lives in the vehicles on their way to the nearest hospital several kilometers away. In order to prevent this, the minority who can afford hospital services, leave their various homes to live in the hospitals several weeks ahead of the time due their delivery. On the other hand, a greater number of the population who cannot afford hospital services stay at home and rely on traditional birth methods. Both sides of the coin have devastating consequences like pressure on limited hospital facilities and risk of complications that may arise with delivery at home. When you query these people about their preference of home delivery by traditional birth attendants to the orthodox mode of health care, they attribute their choice of health care to poverty. Most of them cannot even afford three square meals talk more of the expensive healthcare obtainable in the hospitals. Others also attribute their choice to unavailability of vehicles to transport them to the nearest clinic, traditional beliefs, poor receptions they are being given in the hospitals, and so on.

In this regard, I recommend that as a country, we went back to the proper implementation of the good old primary health care, because that is the only antidote to the high maternal and infant mortality being recorded in our communities. Come to think of it, what is Primary Health Care?

During the declaration of Alma Ata in 1978, the concept of primary healthcare was birthed. Primary healthcare refers to “essential health care” that is based on scientifically sound and socially acceptable methods and technology, which makes universal healthcare accessible to all individuals and families in a community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. In other words, primary healthcare is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. Primary healthcare was introduced to tackle the politically, socially and economically unacceptable health inequalities in all countries but despite enormous progress in health globally, our collective failures to deliver in line with these values (Primary healthcare) are painfully obvious and deserve our greatest attention. We see a mother suffering complications of labour without access to qualified support just like in the scenario above, a child missing out on essential vaccinations, and the impoverishment arising from direct payment for care because of lack of health insurance. These and many other everyday realities of life personify the unacceptable and avoidable shortfalls in the performance of our health systems.

Now, here comes the dreaded question. Has Ghana been able to properly implement primary healthcare since the inception of the concept till date? I’m sorry to burst your bubble, but NO is the perfect answer!

Since the initiation of primary healthcare in this country till date, there have been a lot of shortcomings such as:

  1. Inverse care which occur when people with the most means (the rich) – whose needs for health care are often less – consume the most care, whereas those with the least means (the poor) and greatest health problems consume the least.
  2. Impoverishing care. This affects people who lack social protection and have to pay for healthcare largely out-of-pocket at the point of service. These people can be confronted with catastrophic expenses. Over 100 million people annually fall into poverty because they have to pay for health care.
  3. Misdirected care. Resource allocation clusters around curative services at great cost, neglecting the potential of primary prevention and health promotion to prevent up to 70% of the disease burden. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.

All these effects are seen because proper attention and structuring has not been given to Primary health care. I plead on the government to really invest a lot of resources to properly implement Primary Healthcare at least by making the National Health Insurance Scheme really functional and of great value. How can we claim that the citizens are covered by insurance when they cannot receive proper treatment for common malaria without having to pay extra charges? Of a truth, the implementation of a perfect primary healthcare system is cost intensive but it is going to give a better value for money than any other investment the government would venture in. This is because the implementation of primary healthcare will not only save these pregnant women in question, but will also extinguish outbreaks of deadly epidemics like Cholera, Lassa fever, Ebola, etc., that threaten our country. Just imagine the huge human resources we lose to maternal and child mortality. If majority of those lives were saved, who knows? Maybe, by now, the country would have produced a genius that would bring solution to the numerous problems we face as a country.

I would also suggest to the government to encourage young citizens to come up with initiatives that would help improve healthcare delivery and support them till the materialization of their brilliant ideas. There is a group of students at the University of Cape Coast working on a project to set up a mobile maternity unit and this unit will be in form of a van transformed into a medical facility, consisting of a delivery room, a recovery area and a waiting area. This initiative in line with the implementation of primary healthcare would be essential in the reduction of maternal and infant mortality due to its flexibility in terms of service delivery. I would like to plead to the government and other stakeholders to support initiatives like this, so that in conjunction with the implementation of primary healthcare, the Millennium Development Goal 5 target for maternal mortality which was earlier stated will be achieved.

In conclusion, when we work hard as a nation (both government and stakeholders) and implement primary healthcare perfectly, and support innovative ideas that would help improve the health system, maternal and infant mortality rate will be reduced to the barest minimum. I hope this article appeals to the mind of everyone who would patiently read it until we see a transformation in our mode of healthcare delivery in this country in order to save lives.

Michael Chiagozie Nwobodo
Level 200 Student Physician Assistant
University of Cape Coast, Ghana.

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