In Ghana, maternal and child health has improved considerably during the last 20 years. Nevertheless, the improvements pace is slow to an extent that additional efforts are needed to allow the country realize its fifth millennium development goal (MDG 5) target. MDG 5 aims at minimizing the rates of maternal mortality by over three-quarters (Commonwealth, 2016). In the country, the maternal mortality rates in healthcare institutions have dropped from 216 for every 100,000 live births to around 164 for every 100,000 live births between 1990 and 2010 respectively. Moreover, Ghana and the U.S. have a long engagement history of maternal, neonatal, and child health (MNCH). The relations between the two countries go back to 1957, the year that Ghana attained its independence from Britain. Even though USAID supports most programs that target MNCH, this only represents a small segment of the health engagement the organization has with Ghana. Besides, in 2012, USAID availed approximately $5.5 million to support MNCH initiatives out of the overall Ghanaian budget of over $48.1 million to support the MNCH program. Hence, more resources and efforts are needed to address the issue of maternal health by over three-quarters by the end of 2020 (Bliss & Streifel, 2014).
Significance of the Problem
Ghana appears to have realized notable progress toward realizing its fourth and fifth MDGs in the most prosperous and populous regions in the south of the nation. However, northern provinces health indicators reflect numerous challenges since they have been traditionally underdeveloped. As a result, Ghana failed to realize its fourth and fifth MDGs by 2015. In addition, the growing rate of neonatal mortality is of significant emphasis. To address these issues, the U.S. and Ghanaian governments are working together with other bilateral donors, nongovernmental, and multilateral organizations. Their major goal is to execute various programs that will improve MNCH outcomes. Here, significant emphasis is directed toward northern regions and health of newborns. For instance, the U.S. has contributed over $1.2 billion to Global Alliance for Vaccines and Immunization (GAVI) since 2000. GAVI is a worldwide public-private health partnership that provides access to immunization to poor nations. It has also promoted Ghanas vaccine programs since 2002. Additionally, GAVI finances 7 out of 12 vaccines that Ghana provides to safeguard children health problems at a tender age (Bliss & Streifel, 2014).
Moreover, Ghana has witnessed a decline in rates of maternal mortality from 570 for every 100,000 live births to 380 for every 100,000 live births between 2000 and 2013 correspondingly. Still, the morality rates of children aged below five years declined from 103 for every 1,000 live births to 72 for every 1,000 live births from 2000 to 2013. Nevertheless, irrespective of the progress the country has realized in improving maternal health, the MNCH indicators in Ghana are worse when compared to those of other nations having similar socioeconomic profiles and levels of spending on health care. In addition, the neonatal mortality rates have grown from 30 deaths for every 1,000 live births to 32 deaths for every 1,000 live births between 2008 and 2013. The deaths of newborns represent around 40 percent of mortality rates for children aged below five years. The challenges apparent in this case depict that decision makers and policymakers in the country should consider devising ways of coping with the worsening maternal health situation. This way, they can manage to promote the maternal and child health issue in the country. Doing so would play a key role in boosting the overall maternal and child health in the country (Bliss & Streifel, 2014).
In dealing with the issue of maternal and child health in Ghana, certain policy options and approaches exist in the country.
Per-Service Training Efforts
Pro: The U.S. supports the efforts by Ghana to boost maternal and child health outcomes via Maternal and Child Health Integrated Program (MCHIP). The program focuses on providing training for pre-service in around 32 schools that teach midwifery in Ghana. It also utilizes eLearning to reinforce as well as convey lessons concerning the resuscitation of newborns and vital ways of caring for them. Further, the program plays a major role in supporting the countrywide government in strengthening Community-based Health Planning and Service (CHPS) activities. These undertakings focus on treating diarrheal illnesses, severe respiratory infections, malaria, and avail childhood immunizations as well as services for family planning (Ghana Health Service, 2015).
Con: The effectiveness of the initiative is hindered by the insufficient consultation that exists between stakeholders and formulators at the domestic level. As such, the dissemination of the practices is weak, thus resulting to ineffective implementation (Ghana Health Service, 2015). This is because the initiatives of formulating the policies are usually formulated at national levels without laying out the ideal guidelines for accompanying the policies at local levels. A weak relationship also exists in addressing human resources paucity in the policies contents. This is because have failed to focus on issues of personnel capacities and motivated workforce who drive the policy implementation process. Furthermore, inadequate resources and inefficient infrastructure also pose problems. Therefore, the process of implementation experiences challenges, as no considerations are offered concerning the needed resources and infrastructure (Commonwealth, 2016).
Broadening Vaccine Coverage
Pro: A different effort that Ghana has adopted to address the maternal and child health issue revolves around introducing and broadening vaccines coverage. It does to prevent severe childhood illnesses, such as meningitis, and measles. The program has also played a major role with respect to lowering rates of morality among children aged below five years (Banchani & Tenkorang, 2014). The Expanded Program on Immunization (EPI) in Ghana also ensures that children gain access to around 12 vaccines. Seven of vaccines financed through GAVI. Ghana also emerged as the initial nation that adopted and facilitated the dual introduction of the new pneumococcal and rotavirus vaccines. It managed to do this based on the support it received from GAVI in 2012. During 2013, the coverage of routine vaccination in Ghana was approximately 90 percent. Around less than 1 percent of districts reported coverage rates below 50 percent (Jin, 2016).
Con: The drawback associated with the practice is that it is not possible to reach around 100,000 or 10 percent of the children. This is particularly the case when it comes to children residing in remote districts as well as in peri-urban locations of big cities. Moreover, the practices for maintaining the poor population in certain areas as well as limited resources for consistent outreach services in the case of detached population hinder the success of the program. The affected population mostly comprises of the communities situated in the Volta Basin (UNDP, 2016). In this context, the EPI is forced to sustain motorboats that would facilitate in reaching settlements found in the distant islands of the lake. Therefore, the Health Systems Strengthening (HSS) initiative is focusing on supporting Ghana through GAVI. This will allow the country to cope with some of the hindrances affiliated with the management of vaccines and community outreach. (Bliss & Streifel, 2014)
Supporting Financial Accountability
Pro: The GAVI graduation practice is also a major area of emphasis among officials in Ghana. It requires countries to abandon processes of co-financing vaccines to taking overall financial accountability for their procurement as well as distribution during a five-year duration. The process is initialized after a nation attains a gross national income (GNI) per capita of around $1,530 (Jin, 2016). In the case of Ghana, it has attained 6 percent economic growth rate in the last two decades. This growth has allowed it to realize a $1,760 GNI per capita. Thus, the country has emerged as a lower-middle-income nation according to the World Bank. This way, the country would manage to take financial responsibility for procurement and distribution initiatives (Ghana Health Service, 2015).
Con: Various concerns have arisen regarding health gains that would be realized from the recent activities that receive support from GAVI. The process would be lost in the event of poor management. Furthermore, the government would need to budget for more than $25 million to allow it realize its goal of financing the vaccines. This practice would result to the imposition of additional financial burdens in the country. However, questions arise as to whether Ghana would manage to continue the process of procuring the vaccines effectively once it abandons GAVI support (Commonwealth, 2016).
In improving maternal health in Ghana by over three-quarters by 2020, the ideal solution to focus on is availing sufficient in-service training (IST). The technique would play an essential role with respect to ensuring that midwives receive updated practices in offering maternal health care services. Through providing sufficient IST, incidences of maternal mortality would decline considerably (Jin, 2016). Moreover, addressing the midwives clinical competences through regular IST would make the contemporary medical care relevant in the context of maternal health. For instance, it is worth noting that health care providers with sufficient clinical competencies in providing emergency obstetric care are limited (Jin, 2016). Various reasons exist as to why many nations lack sufficient numbers of skilled individuals to offer midwifery services. For instance, the individuals contending with human resources fail to pay significant attention to proficiency needs in the various competencies needed in assisting newborns and women. For a long time, health workers have received insufficient midwifery training. Here, it is appropriate to clarify on the need for understanding competency. The key areas of emphasis here comprise of capacity to perform job, skills and knowledge, as well as the behaviors that midwives should portray to promote safety in any health care environment (UNDP, 2016).
In the Ghanaian context, therefore, the implementation of the IST policy would require the individuals involved in its execution to ensure they have sufficient knowledge concerning what the policy entails. They should take part in the process of formulating the policy. Doing so would ensure that the policy becomes successful through fostering support and commitment (Banchani & Tenkorang, 2014). In the case of developing nations, such as Ghana, they usually implement policies by following a top-down mechanism. However, they fail to communicate with the parties who take part in delivering health services. As such, the maternal policy dissemination ends up weak. Communication also plays a critical role with regard to ensuring that policies emerge successful. In the event of poor communication, the process of implementing a policy would be ineffective (Banchani & Tenkorang, 2014). Therefore, while implementing the IST policy, the decision makers should ensure they specify and clarify the relevant policies to deploy. This way, they would ensure that the appropriate personnel understand it to facilitate successful implementation. Thus, through following the IST guidelines, Ghana would manage to incorporate an effective policy of improving maternal health across by over three-quarters by 2020 effectively.
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