Maternal deaths and health institutional reforms

Not too long ago, I heard the President of Ghana, His Excellency, John Dramani Mahama, telling his chief executives to embark on a street-naming and house-numbering exercise, and that their continuous stay in office would depend on their performance in this exercise. By all standards, this is a very measurable and specific objective which, when carefully monitored, will produce the desired results.

This quickly reminded me of my earlier article I wrote about measures needed to reduce maternal deaths. In the said article (Daily Graphic, November 21, 2006, P 11), I enumerated the key causes of maternal mortality and mentioned that emergency obstetric care must be at the centre of all programmes needed to reduce maternal deaths.

I suggested that all health facilities be labelled and earmarked as providing basic or comprehensive emergency obstetric care (EOC) which must be clearly indicated on their main signpost or written clearly where any passer-by could read, just as the numbering of houses being demanded by the president.

Maternal deaths may be increasing because people are not utilising existing health facilities, simply, because they know or perceive that they will not receive the needed care (emergency obstetric care) in the event of developing complications during and after labour. This may explain all the delays that are associated with their health-seeking behaviour and decision-making.

Reforms

Reforms must start in health facilities, and just as a number of facilities have declared themselves as baby-friendly, all health facilities must indicate the extent to which they are able to help in the event of obstetric emergencies.

This will constantly remind workers of their calling and, therefore, put the appropriate measures in place to handle complications of pregnancy which account for about 75 per cent of all maternal deaths. These include bleeding (obstetric haemorrhage), pregnancy-induced hypertension, obstructed labour and unsafe abortion.

The criteria for belonging to either basic or comprehensive EOC facility (which are also known as signal functions ), as jointly agreed by world health experts include (for basic services), include the ability to perform manual removal of placenta, administer by injection  anticonvulsants, oxytocic’s, antibiotics, removal of retained products of conception and performing assisted-vaginal delivery. For comprehensive services, they include all the above measures and in addition to providing blood transfusion and performing caesarian section.

It can be seen that most health centres and maternity homes can and should be able to provide basic EOC, while all hospitals must provide comprehensive EOC. Those who may not be able to identify their facilities as belonging to either basic or comprehensive due to lack of resources must be assisted to do so.

I am not sure if the Ministry of Health would also like to declare that all heads of government facilities would be assessed to either continue to occupy their posts or vacate them based on how much they perform in terms of labelling their facilities and applying themselves to being EOC friendly.

Annual awards

Annual awards can also be given to institutions which are able to manage well all emergency cases they receive within the limit of their resources.

There is no doubt that maternal deaths will be brought to the barest minimum if facilities are labelled this way and staff show commitment to exactly what they have pledged to do.

The writer is the Medical Superintendent,  Medical Superintendent, Konongo-Odumasi Government Hospital ( kwakukese@yahoo.com)