Despite priority placed on maternal mortality within the Millenium Development Goals (MDGs) framework, there is a long way to go in overcoming one of the most pressing challenges in providing health care in resource-poor settings such as northern Ghana.
The availability and distribution of trained personnel, including physicians, midwives, nurses, and other clinical staff to provide the required health services to the people of the region seems challenging.
According to the 2010 MDGs Ghana report, the three northern regions shoulder substantial burden of Ghana’s maternal mortality, but it is home to less than three per cent of Ghana’s health care workers.
Northern Region faces critical shortages of various categories of health professionals including doctors, midwives, nurses, and other clinical staff.
The pool of skilled healthcare providers at the disposal of the region are unevenly distributed and concentrated in the regional capital, with many of them doubling in part-time jobs (locum) in the private facilities.
As a result, the majority of districts considered rural, often hard to reach, and remote areas are also resource-poor and have minimal access to skilled health care providers giving the necessary treatment and care.
Nanumba South District is one such district considered rural with critical shortages of health workers in key essential service areas.
This was disclosed by the District Director of Health Services, “Look, in one of my sub-districts you can only get there by boat over the Oti River or you go there through Yendi and Zabzugu district before coming back to the sub-district and we do not even have a midwife there to conduct delivery.
Can you imagine what will happen if a labouring woman needs a referral from such a place?â€. This is the frustration of the district director of health services for Nanumba South when I visited her district recently.
The geographic terrain has also worked to define the location and preference of health workers even within the district. Local health personnel tend to flock to the health facility with the best resources (Wulensi Health Centre), which is in the district capital.
The desire of health workers to want to be at the district capital is natural so they can enjoy the benefits of better facilities and the conveniences associated with living in a more populated area.
This is a problem because more than half of the people in the district live in the rural areas, yet all the midwives live in the district capital or urban centres leaving the rural inhabitants of this district without access to skilled health delivery during labour.
The irony of this arrangement is that the policy of the Ghana Health Service (GHS) is that no traditional birth attendant (TBA) should conduct deliveries even for people living in rural areas where there are no health facilities. They should rather refer labouring women to the health facilities even if there are no midwives in such facilities.
The real question is, is it possible to achieve universal skilled delivery coverage when we have an unequal distribution of midwives? How can this anomaly be corrected within the short to medium term to promote access to prenatal care and safe delivery in the rural areas of deprived districts such as Nanumba South?
I think this is a call for the GHS particularly the district health management team (DHMT) in Nanumba South District to try to counter the “centripetal force†of the urban centres by supporting staff in health centers located in rural areas to increase rural clients’ access to prenatal care.
Investing in staff training, offering fair incentives, and creating support networks through the available avenues created by the health system will help retain critical skilled personnel in the rural areas to provide essential care services to the population in need.
One of such training opportunities is the programme that allows DHMTs to sponsor community health officers who have worked for a certain number of years in the district to enrol directly in midwifery training. This will enable the DHMTs to bond the beneficiaries and keep them in facilities located in rural areas for at least two years.
The DHMT should also take a second look at its staffing policies for different health facilities in their catchment area and plan whether gaps exist that need to be filled. In planning for staffing and training, they should consider how they can harmonise their staffing needs with service policy and standards and align with priority needs of the district to help overcome staff shortages.
It is all about priority setting, leadership decision-making, and choices.
Finally, the DHMT should constitute a quality improvement (QI) team to test changes aimed at addressing the skills gaps for prenatal care in their district. Even though this may be a long term solution, it will afford the opportunity to test local solutions in human resource capacity building in the district.
By Solomon A. Attinbire/Daily Graphic/Ghana
— The writer is the Senior Monitoring & Evaluation Officer of Project Fives Alive
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