Kyei-Onanjiri Minerva, Carolan-Olah Mary, Awoonor-Williams John Koku, McCann Terence V
Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
Ghana Health Service, Accra, Ghana.
BMC Health Serv Res. 2018 Mar 15;18(1):184. doi: 10.1186/s12913-018-2980-6.
Maternal morbidity and mortality is most prevalent in resource-poor settings such as sub-Saharan Africa and southern Asia. In sub-Saharan Africa, Ghana is one of the countries still facing particular challenges in reducing its maternal morbidity and mortality. Access to emergency obstetric care (EmOC) interventions has been identified as a means of improving maternal health outcomes. Assessing the range of interventions provided in health facilities is, therefore, important in determining capacity to treat obstetric emergencies. The aim of this study was to examine the availability of emergency obstetric care interventions in the Upper East Region of Ghana.
A cross-sectional survey of 120 health facilities was undertaken. Status of emergency obstetric care was assessed through an interviewer administered questionnaire to directors/in-charge officers of maternity care units in selected facilities. Data were analysed using descriptive statistics.
Eighty per cent of health facilities did not meet the criteria for provision of emergency obstetric care. Comparatively, private health facilities generally provided EmOC interventions less frequently than public health facilities. Other challenges identified include inadequate skill mix of maternity health personnel, poor referral processes, a lack of reliable communication systems and poor emergency transport systems.
Multiple factors combine to limit women's access to a range of essential maternal health services. The availability of EmOC interventions was found to be low across the region; however, EmOC facilities could be increased by nearly one-third through modest investments in some existing facilities. Also, the key challenges identified in this study can be improved by enhancing pre-existing health system structures such as Community-based Health Planning and Services (CHPS), training more midwifery personnel, strengthening in-service training and implementation of referral audits as part of health service monitoring. Gaps in availability of EmOC interventions, skilled personnel and referral processes must be tackled in order to improve obstetric outcomes.
孕产妇发病和死亡在撒哈拉以南非洲和南亚等资源匮乏地区最为普遍。在撒哈拉以南非洲，加纳是在降低孕产妇发病和死亡率方面仍面临特殊挑战的国家之一。获得紧急产科护理（EmOC）干预措施已被确定为改善孕产妇健康结局的一种手段。因此，评估医疗机构提供的干预措施范围对于确定治疗产科紧急情况的能力很重要。本研究的目的是调查加纳上东部地区紧急产科护理干预措施的可及性。
对120家医疗机构进行了横断面调查。通过向选定机构的产科护理单位主任/负责人发放由访谈员填写的问卷来评估紧急产科护理状况。使用描述性统计方法分析数据。
80%的医疗机构不符合提供紧急产科护理的标准。相比之下，私立医疗机构提供EmOC干预措施的频率普遍低于公立医疗机构。确定的其他挑战包括产科卫生人员技能组合不足、转诊流程不佳、缺乏可靠的通信系统和紧急运输系统不完善。
多种因素共同限制了妇女获得一系列基本孕产妇保健服务的机会。研究发现该地区EmOC干预措施的可及性较低；然而，通过对一些现有设施进行适度投资，EmOC设施可增加近三分之一。此外，通过加强现有的卫生系统结构，如社区卫生规划与服务（CHPS）、培训更多助产人员、加强在职培训以及作为卫生服务监测一部分实施转诊审核，可以改善本研究中确定的关键挑战。必须解决EmOC干预措施、技术人员和转诊流程可及性方面的差距，以改善产科结局。
