Using the community-based health planning and services program to promote skilled delivery in rural Ghana

Evelyn Sakeah, Boston University and Navrongo Health Research Centre
Lois McCloskey, Boston University
Judith Bernstein, Boston University
Kojo Yeboah-Antwi, Boston University
Samuel Mills, World Bank Group
Henry V. Doctor, United Nations Office on Drugs and Crime (UNODC)

The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal mortality and morbidity, yet in 2008 only 55% 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 assessed the extent to which skilled delivery program has been implemented as an integrated component of the existing CHPS as well as the benefits and challenges of the program. Method: 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. Findings: The CHO-midwives provide integrated services that include skilled delivery in CHPS zones. They referred pregnant women with complications to district hospitals and health centers for care and the referral system has improved. The CHO-midwives collaborate with District Assemblies, Non-Governmental Organizations (NGOs) and communities to offer skilled delivery services in rural communities. Stakeholders perceived improved skilled deliveries, health education, antenatal attendance, postnatal care and reduced maternal deaths in rural communities. The CHO-midwives are provided with financial and non-financial incentives to motivate them for optimal work performance. Conclusion: Our study demonstrates that CHOs can be successfully trained as midwives and deployed to provide integrated services including skilled delivery services at the doorsteps of rural households. The primary challenges that remain include inadequate numbers of CHO-Midwives, insufficient transportation, and infrastructure weaknesses.