Guttmacher Institute, 125 Maiden Lane, 7th floor, New York, NY, 10038, USA.
Vital Strategies, 100 Broadway, 4th Floor, New York, 10005, USA.
BMC Health Serv Res. 2021 Oct 15;21(1):1104. doi: 10.1186/s12913-021-07141-5.
Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana.
We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision.
Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity.
Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care.
SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.
加纳是撒哈拉以南非洲国家中少数几个堕胎法相对较为宽松的国家之一，但全国范围内堕胎服务的可及性和质量知之甚少。本研究旨在描述加纳卫生机构提供基本 PAC 和 SAC 服务的能力和资源。
我们利用了一项对加纳有能力提供堕胎后护理（PAC）和/或安全堕胎护理（SAC）的卫生机构进行的全国代表性调查的数据（n=539）。我们包括了在过去一年中报告提供 PAC（57%）或 SAC（19%）的 326 个机构。我们利用信号功能方法评估了设施提供高质量基本和综合护理的基础设施能力。我们进行了描述性分析，以估计有能力提供 SAC 和 PAC 的初级和转诊设施的比例，以及在能力较高的设施中进行的 SAC 和 PAC 的比例，并进行分数回归分析，以探讨与提供更高结构能力相关的因素。
不到 20%的提供 PAC 和/或 SAC 的机构符合基本或综合 PAC 或全面 SAC 的所有信号功能标准。较高的 PAC 病例数和接受过真空吸引培训的工作人员与初级和转诊设施提供 PAC 的能力较高有关，而私营/宗教机构所有和农村地区与转诊设施提供 PAC 的能力较高有关。农村地区的初级设施与基本 SAC 能力较低有关。
总体而言，很少有公共设施具有提供加纳全面堕胎护理所有信号功能的基础设施能力。通过促进所有目前提供堕胎后护理的卫生机构提供服务，有可能扩大安全堕胎护理的提供。
总的来说，SAC 的提供远远低于 PAC，但在初级设施提供基本 PAC 的能力方面仍存在持续差距。这些结果突显了加纳卫生部需要改善卫生机构提供全面堕胎护理的基础设施能力的必要性。
