Ghana?s Maternal Health: Resources Can Make the Difference-Kamara


downloadSEND-GHANA has launched a health research report titled ?Halting Needless Death of Women: The Need for Priority Investment in Maternal Healthcare Delivery in Ghana? in Accra.
Speaking at the launch, Mr. Siapha Kamara, Chief Executive Officer of SEND-WEST AFRICA said, many times government believes Civil Society Organisations (CSOs) are their enemies but this should not be the case. ?Our work is not to make government look bad. We are like unpaid auditors who give alternative views in order to reduce corruption and maximize accountability.?
Ghana is touted as a nation that is on its way to attain many of the MDGs having succeeded in achieving MDG 1 in 2006 and made significant progress MDGs 2, 3, 6 and 8.
But the pace of progress suggests that Ghana is unlikely to attain the goal of reducing maternal mortality rate by three-quarters by 2015.
We need to double up our efforts in the maternal health care. Resources are critical. The amount given out of the approved funds is usually less than thirty per cent (30%). Out of this, about ninety per cent (90%) goes into payment of salaries of health professionals, according to Dr. Ernest Tei Maya, a Senior Specialist, Obstetrics and Gynaecology and reviewer of the report.
According to Kamara, maternal health issue is unfortunately one of the heaviest tasks that Ghana is faced with.
He however believes that resources can help make the difference in Ghana?s ailing health sector.

The health study which was conducted to identify the sources of funding to 6 district health facilities for provision of maternal health services examined issues of public financial management mechanisms as it pertained to budget transparency and credibility and assessed the utilisation of funds for improved maternal health services at 6 district health facilities.
The findings show that the health sector draws its funds from three main sources (Government of Ghana, Internally Generated Funds and donor funds) and enjoys significant support from over 30 donors.
However, yearly donor disbursement is not always intended for family planning and maternal healthcare interventions.
Annual budget allocations to the health sector in nominal terms has seen increases over the years, however it still falls short of 15% of the national budget in compliance with the Abuja Declaration. Till date government allocation has been fluctuating between 10.5% and 12.5%. In 2011 and 2012, there was significant improvement in internally generated funds with higher contribution to the health sector?s budget than any single source; be it Government of Ghana (GOG) or development partners.
The study observed that over 90% of government?s contribution to the health sector overall budget is used to settle emoluments of health staff leaving less than 10% for investments.
The implication is that the sector largely depends on donor support and internally generated funds to implement its activities.
Even though the sector does not receive its entire share of budget allocations, the situation is better at the district health directorates and facility level where over 80% of their budgets request is honoured from varied sources. However, the GHS discriminate against some districts. Evidence from the study show that between 2009 and 2012, only Agona East consistently received funds from GHS. Suhum received funds in 2012 whiles Ejura, Kpandai and East Mamprusi did not receive funds.
The health sector budget at both national and district level are not disaggregated for spending in specific health areas therefore making it difficult to determine the specific allocations and disbursement for family planning and maternal healthcare services.
The findings revealed that in accordance with recommendations from the 2006 MDGs progress report, some DHDs and Health facilities are disbursing a percentage of their total funds for family planning and maternal healthcare service provision. This is laudable. The percentage however is not uniform across the board and has been reducing on yearly basis.
Financial constraints hinder DHDs and facilities effort to providing adequate health facilities including well-equipped CHPs compounds and skilled personnel to man the facilities. It also impacts on the ability of DHDs to carry out continuous extensive educational outreach programmes to boost citizens? acceptance of family planning and to access antenatal, supervised deliveries and postnatal care services.
In spite of the vast nature and huge population sizes of the surveyed districts, majority (Agona East, Amansie West, East Mamprusi and Kpandai) have no district hospitals. Residents, including pregnant women have to travel long distances to access care.
With the exception of Agona East and East Mamprusi, the remaining districts did not have full complement of health professionals who support family planning and maternal healthcare service provision. For instance, Agona East and East Mamprusi had no medical doctors. Suhum had no medical assistants or anaesthetist; Kpandai can boost of only 3 midwives even though they require 40 and, Agona needs 35 but has only 11 midwives.
Similarly, lack of critical equipment and logistics such as ultra sound scanners, delivery beds, weighing scales, pressure machine (Syphg), oxygen equipment, laboratory, blood banks and ambulance service mirrors inadequate investment in area and has serious implications for delivering emergency obstetric care to women.
The study observed that majority of health facilities are denying clients the full benefits of the National Health Insurance Scheme. Thus, even though the benefits package includes free feeding for in-patients who are insured and are using NHIS accredited facilities, the facilities do not provide such services to clients. Moreover, pregnant and post-partum women registered with the NHIS continue to pay for some services including medicines, ultra sound scans and some laboratory examination. What is more worrying is that demands for pregnant women to provide items such as dettol, blades, soap and rubber sheets sometimes deter them from accessing the facilities to deliver.
The budget credibility of the sector is often undermined as a result of inadequate and untimely release of funds from government and other sources as well as actual expenditure on maternal health as compared with allocations. For the past four years, 50% of the directorates have not received funds from neither government nor MMDAs to support maternal healthcare provision. The channel of transfer to the districts also complicates the already poor situation.
Dishonouring budgets and/or cutting fiscal request as well as delays in funds transfer consistently affects the smooth operations of the hospitals and DHDs
Although the District Health Directorates and Facilities provided stakeholders and opinion leaders with health information, they rarely shared fiscal information including those that border on maternal health with citizens. Citizens are not also involved in health budget planning. This state of affairs does not promote transparency in the allocation and utilisation of funds earmarked for the implementation of maternal healthcare programmes.
In view of the findings, it is recommended that, government should increase its financial commitments for investments and goods and services which support maternal healthcare and family planning services instead of depending on donor assistance by broadening its revenue base in order to have dedicated source to finance maternal healthcare.
This is because in the event of donor withdrawal, maternal health outcomes will be seriously affected.
The Ghana Health Service should make it mandatory for the DHDs and facilities to consistently use defined percentage of their IGF to support maternal healthcare.
There is the need for Ghana Health Service and its development partners to dialogue and devise means of merging fragmented maternal health programmes/interventions and funds for proper coordination, harmonisation and alignment. In so doing utilisation can be streamlined and properly accounted for on mutual grounds.
Given the importance of the general healthcare provision and in particular maternal healthcare in the communities, the District Assemblies ought to incorporate maternal healthcare into their medium term development plans and adequately budget for it and in so doing guarantee yearly funding to promote maternal health in the districts.
The GHS has to provide health facilities including CHPs compounds and zones with the required basic logistics such as weighing scales, pressure machines(Sphyg), motor bikes, bicycles, ultra sound scanners, laboratories to enable them work effectively. Additionally, since haemorrhage is the highest contributor to maternal deaths, establishing blood banks and ambulance services in every district should be highly considered to bring the service closer to the people.
For the National Health Insurance to serve its full purpose of providing free delivery services to women, the Ghana Health Service should encourage health facilities to provide at least one nutritious meal for women who have put to birth.
To contribute to strengthen public financial management systems for funding maternal health at the district level, it is essential for District Health Directorates and Facilities to make health budget and programme information accessible to increase citizens? awareness in the districts and to seek their support for resource mobilisation and successful implementation of programme.
We will work with this report and whatever we need to do we will do it, Dr. Maya assured.

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