Improving access and utilization of emergency obstetric care in Tano District, Ghana

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The primary means of preventing maternal deaths is to provide rapid access to emergency obstetric care. Previous research in many developing countries showed that underlying causes of high maternal mortality were related to delays in seeking care, reaching health facilities and in getting prompt treatment at the health facilities. This research was conducted to determine the factors affecting access and utilization of emergency obstetric care in Tano District and measures for improvement. The study was descriptive cross-sectional which was qualitative and quantitative in design. The data was collected from males and females of reproductive age, traditional birth attendants and members of staff of the district hospital and Techimantia health centre. Tools for data collection include focus group discussions guide, structured interview guides, questionnaires and checklist. Information was collected on knowledge of danger signs in pregnancy among community members, decision to seek emergency obstetric care and the quality of care at the health facilities. The findings of the study revealed that poor knowledge of obstetric complications, difficulties in paying for transport and inadequate number of doctors as major barriers to seeking and reaching emergency care for obstetric complication. More than half (57%) of 100 women interviewed had poor knowledge of danger signs in pregnancy. Out of 25 men interviewed, B6% had poor knowledge of the danger signs in pregnancy while 40% of the 13 traditional birth attendants had poor knowledge of danger signs in pregnancy which affects their ability to make prompt referrals of pregnancy complications to health facilities. Utilization of obstetric services in the district is generally poor. In spite of 100% antenatal coverage 52% of the women interviewed had home deliveries with the assistants of traditional birth attendants about half of whom were untrained. The high cost of emergency transport made it difficult for community members to access emergency obstetric care. More than half (54%) of women who visited a hospital due to pregnancy complication or childbirth paid transport cost between 040,000 and 080,000, while 22% paid above 080,000. Majority (70.8%) of respondents do not receive an average monthly income above 0200,000. This low level of income made it difficult for most of the respondents to pay the high emergency transport cost. The district hospital has only one medical doctor instead of two as required by the hospital administration. In some cases women with complications were referred to other hospitals in the region which contributed to the delay in seeking emergency obstetric care. The results also showed that waiting time and attitude of health staff towards clients were not major factors affecting access and utilization of emergency obstetric care in the district. It can be concluded from the findings that lack of knowledge of danger signs in pregnancy and high cost of transport were the major factors affecting access and utilization of emergency obstetric care in the district. The Ministry of Health needs to provide ambulance services at the district hospital to help reduce the acute problem of transport. The District Health Administration could also intensify its education programmes to all adult community members on danger signs in pregnancy and the need to seek prompt care during pregnancy complications.
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi in partial fulfilment of the requirements for the award of the degree in Master of Science in Health Services Planning and Management, 2005