Sakeah Evelyn, McCloskey Lois, Bernstein Judith, Yeboah-Antwi Kojo, Mills Samuel, Doctor Henry V
Social Science Unit, Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana.
BMC Health Serv Res. 2014 Aug 11;14:340. doi: 10.1186/1472-6963-14-340.
In Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery. The Ghana Health Service piloted a strategy that involved training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). CHO-midwives collaborated with community members to provide skilled delivery services in rural areas. This paper presents findings from a study designed to assess the extent to which community residents and leaders participated in the skilled delivery program and the specific roles they played in its implementation and effectiveness.
We employed an intrinsic case study design with a qualitative methodology. We conducted 29 in-depth interviews with health professionals and community stakeholders. We used a random sampling technique to select the CHO-midwives in three Community-based Health Planning and Services (CHPS) zones for the interviews and a purposive sampling technique to identify and interview District Directors of Health Services from the three districts, the Regional Coordinator of the CHPS program and community stakeholders.
Community members play a significant role in promoting skilled delivery care in CHPS zones in Ghana. We found that community health volunteers and traditional birth attendants (TBAs) helped to provide health education on skilled delivery care, and they also referred or accompanied their clients for skilled attendants at birth. The political authorities, traditional leaders, and community members provide resources to promote the skilled delivery program. Both volunteers and TBAs are given financial and non-financial incentives for referring their clients for skilled delivery. However, inadequate transportation, infrequent supply of drugs, attitude of nurses remains as challenges, hindering women accessing maternity services in rural areas.
Mutual collaboration and engagement is possible between health professionals and community members for the skilled delivery program. Community leaders, traditional and political leaders, volunteers, and TBAs have all been instrumental to the success of the CHPS program in the UER, each in their unique way. However, there are problems confronting the program and we have provided recommendations to address these challenges.
在加纳，每年有1400至3900名妇女和女孩死于与妊娠相关的并发症，据估计，其中约三分之二的死亡发生在妊娠晚期直至分娩后48小时内。加纳卫生服务局试行一项战略，即培训社区卫生官员（CHO）成为助产士，以解决上东部农村地区（UER）熟练接生服务的缺口问题。CHO助产士与社区成员合作，在农村地区提供熟练接生服务。本文介绍了一项研究的结果，该研究旨在评估社区居民和领导人参与熟练接生计划的程度，以及他们在计划实施和成效方面所发挥的具体作用。
我们采用了带有定性方法学的内在案例研究设计。我们对卫生专业人员和社区利益相关者进行了29次深入访谈。我们使用随机抽样技术在三个基于社区的卫生规划与服务（CHPS）区域中挑选CHO助产士进行访谈，并使用目的抽样技术确定并访谈来自这三个区的卫生服务 district directors、CHPS计划的区域协调员以及社区利益相关者。
社区成员在加纳CHPS区域促进熟练接生护理方面发挥着重要作用。我们发现社区卫生志愿者和传统助产士（TBA）有助于提供关于熟练接生护理的健康教育，并且他们还会为其客户介绍或陪同他们去找熟练的接生人员。政治当局、传统领导人以及社区成员提供资源以促进熟练接生计划。志愿者和TBA都会因介绍其客户接受熟练接生服务而获得经济和非经济激励。然而，交通不便、药品供应不频繁以及护士的态度仍然是挑战，阻碍着农村地区的妇女获得孕产妇服务。
卫生专业人员和社区成员之间对于熟练接生计划进行相互协作和参与是可行的。社区领导人、传统和政治领导人、志愿者以及TBA都以各自独特的方式对UER的CHPS计划的成功起到了重要作用。然而，该计划面临一些问题，我们已提出建议以应对这些挑战。
