Reducing maternal and newborn deaths
It was during the period of the UN decade for women from 1975-1985 that the plight of majority of women entered the consciousness of officialdom. At that time the alarming rate of maternal deaths was estimated to be over half a million each year, and the majority were in developing countries.
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Consequently, a programme was designed by an international team to reduce the deaths by orienting the service towards the treatment of all complications as emergencies in health facilities. This turned out to be life saving for pregnant women. Today, this, along with other strategic measures which were the results of an eight-year collaborative study in West Africa have become standard practice in most health institutions.
Ghana Prevention of Maternal and Mortality (GPMM)
This year marks 25 years of engagement of the Ghana Prevention of Maternal and Newborn Mortality (GPMM), a member of a network of non-governmental organisations in Africa that uses local professionals to undertake multi-disciplinary and action-oriented activities to address maternal and newborn complications. The teams are made up of medical personnel- obstetricians, paediatricians, community health physicians, nurses, midwives, social scientists, journalists, etc.
This unique composition made it possible for teams to gain considerable experience in conducting assessments of the conditions that prevented ready access to quality care in designing appropriate interventions, and where possible, helping with the implementation and monitoring of the outcomes in a given district.
The organisation collaborates with communities, local government bodies, the Ministry of Health, other NGOs, traditional leaders and the private sector to ensure that appropriate measures are put in place to achieve their objectives. The team also maintains relationships with other African and international agencies and NGOs.
GPMM activities
Activities to mobilise the communities include raising awareness to change attitudes about pregnancy and childbirth while directly engaging their energies to contribute towards reducing maternal and newborn deaths. The efforts prove fruitful as communities often task themselves to contribute their quota in relevant ways to support institutional efforts.
For example, a new willingness to donate blood to augment hospital supplies has been demonstrated in many of the sites. Also transport associations, especially the GPRTU of Ghana, enthusiastically engaged themselves and laid out plans and mechanisms for transporting the pregnant to care centres quickly,and in many cases repairs were made to local ambulances and a means of establishing communication links were found for easy transfer of referral cases.
Even within individual pregnant women’s homes a mechanism was set up to assist families who had financial difficulty. This involved communities mobilising themselves to raise funds to set up short term loan schemes out of which soft short term loans were given to assist families facing difficulties during the critical periods. In all the sites, this financial assistance was the first of its kind and in Ghana it had proved to be a precursor of what is now offered under the National Health Insurance Scheme. In some communities, even the private sector was engaged in the provision of obstetric care at an agreed rate.
Needs assessment
Since 1997 the organisation has focused on the challenges faced in the provision and utilisation of Emergency Maternal and Obstetric Care (EMOC) and Emergency Newborn Care (ENC) for the reduction of the death rate in many districts in Ghana. Under the leadership of Dr J.B Wilson, GPMM has carried out Needs Assessments from the Northern to the southern regions of the country which indicated priority areas that must be addressed. All districts in the Upper West and Upper East regions were assessed, as well as five Northern Region districts,comprising Zabzugu, Tatale, Yendi, Bole and Tamale.
In the Brong Ahafo Region, the assessment of the state of maternal health was carried out in Jaman South. Similar exercises were conducted in Juaben, Ejisu, Bosomtwe in the Ashanti Region and Assin and Mfantseman in the Central Region. Two districts each were covered in the Eastern, Greater Accra and Western regions.
In this last region, one of the local mining companies provided funds for an important intervention- the construction of a 50-bed maternity hospital with a theatre for caesarean sections in the Wassa Amenfi District.
This is an excellent example of cooperation of five groups working together to provide up-to-date facilities for pregnant women. The synergies between GPMM, WHO, the then MP for Tarkwa Nsuaem Constituency, a local mining company and the Wassa West District, made the construction and equipping of the facility possible within a record time for the needy women of the area to use.
The problems of poor transportation, lack of equipment, cost of medical care are also addressed through improvisation, using available resources and enlisting community participation to design innovative measures using local resources.
In the last decade or so, Ghana has made commendable strides in implementing some of the interventions mentioned above. Additionally, some international bodies, including UNICEF, UNFPA, WHO, have donated funding for specific activities at the community level to help raise awareness. The GPMM teams also received financial support from some district assemblies that saw the need to contract the organisation to undertake needs assessment. In addition to the assessments, capacity building activities were also carried out where funds were available, and the African Women’s Development Fund proved helpful.
The organisation is also able to assist with advocacy and consensus building to help establish availability of EMOC and ENC on a 24 hour basis. This can be done by refurbishing facilities, to repair, renovate or purchase equipment, furniture, with the help and support of government, community and other agencies. In all of these, GPMM encourages community ownership of the projects while helping to empower communities in hard-to-reach and remote areas to actively participate in the delivery of EMnOC services.
Training programmes
GPMM also has experience in mobilising competent staff to run training programmes, hold planning workshops, seminars and conferences and lead discussions in the relevant areas of maternal and newborn care. Since it is important to emphasise monitoring and evaluation of interventions GPMM has developed simple and sustainable methods by which health facilities can assess the quality of their services, and also identify the types of current obstetric problems they have and how to address them. GPMM also tracks the costs of different interventions and the contributions made by different bodies.
Regional Prevention of Maternal Mortality
The activities of the GPMM were facilitated by the establishment of an office of a network of PMMs teams -the Regional Prevention of Maternal Mortality [RPMM] in Accra between 1996 and 2010. The aim was to mobilise teams in other countries in Africa and provide them with information on the methods used, lessons learnt and build their capacities to replicate the PMM model in their countries. Within the period, some 20 more countries across Africa—Tanzania, Zambia, Togo, Burkina Faso, Angola and Cote d’Ivoire, to name a few,— came to undertake this capacity building exercise.
Several capacity building and training workshops, conferences and seminars have been held across Africa and in Ghana over the last ten years. Many useful publications and newspaper articles have also been put out as general information for the public.
GPMM activities curtailed
Since 2011, the activities of the organisations have been curtailed due to lack of funds but there are still teams that are willing to assist further to reduce the levels of maternal and newborn deaths especially in the light of the experience gained over the 25 years when the PMM was born.
Governments can accelerate the pace of reducing maternal and newborn deaths by adopting some of the tried and tested PMM innovative measures and systematically put them in place in the next five years without recourse to crash programmes/ fire brigade approaches. Many of the PMM teams have similar competencies as the GPMM which over the last decade has established itself as a leader in the field.
Credit: The Ghana Prevention of Maternal Mortality Team