Spatial distribution of EmONC services in Ghana
Evidence for Action’s second series of papers published in the International Journal of Gynecology and Obstetrics (IJGO) focuses on different views and evidence on quality of care for mothers and newborns. This paper highlights gaps in the geographic availability of key life-saving services for mothers and newborns and uses thematic maps to illustrate sub-regions that require priority attention.
The first nationwide EmONC assessment in Ghana was conducted in 2010. Basic EmONC facilities were defined as primary healthcare facilities that provided the seven basic 'signal functions', key life-saving interventions, in the three months prior to the EmONC survey, such as administer unterotonic drugs, intravenous antibiotics and anti-convulstants; perform assisted vaginal deliveries, removal of retained placenta and basic resuscitation of newborns. Comprehensive EmONC facilities were defined as secondary and tertiary healthcare facilities that provided the seven basic signal functions above, as well as perform Caesarean delivery and safe blood transfusions.
For each region, the difference between the recommended number of basic and comprehensive EmONC facilities (based on international standards) and the actual number of functioning facilities (based on the definition above) was calculated. The proportion of facilities with only one or two signal functions missing was analysed too.
In addition, the authors developed thematic maps to show the location of basic, comprehensive and nearly functioning EmONC facilities per district, and the proportion of pregnancies delivered at these facilities.
- Of 1,159 maternity facilities nationwide, only 13 were functioning basic EmONC facilities and 76 were functioning comprehensive EmONC facilities (based on the definitions above)
- At national level, there was a shortfall of 153 functioning EmONC facilities, but this varied across regions
- Many facilities were ‘nearly functioning’ i.e. missing only one or two signal functions
- Only one in five facility-based births were in functioning EmONC facilities, but a further 30% were in facilities missing one or two basic signal functions
- The two most common missing signal functions were assisted vaginal delivery and removal of retained products
- At national level, Ghana would meet the international standard of functioning EmONC facilities per population if the ‘nearly functioning’ facilities were upgraded
- Due to variations in fertility rates across Ghana, it is important to consider ‘need’ for maternity facilities in terms of estimated pregnancies, not only population
Conclusions and key recommendations
The availability of EmONC services in Ghana does not meet international standards. However, by addressing gaps in the provision of two signal functions – assisted vaginal delivery and removal of retained products – would have allow Ghana meet international standards for availability of EmONC services.