The long path to maternal health
Three days before giving birth to her son, Deborah Zatey descended from her village of Wli Todzi, a community far above the famous Wli Falls in the Volta Region, down a hazardous mountain path towards Wli, the nearest village with road access.
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“I walked alone down the mountain. I had pains all the way,” says Zatey, referring to her ordeal.
After arriving at Wli, she got a car to Hohoe, where she later gave birth.
The 21-year-old had never given birth in her village because it is too dangerous. Many women who have tried to give birth in the village and experienced complications have had to be carried down the mountain. Often, by the time they reach Wli, they would have already bled to death.
She says she doesn’t want to risk being transported down the mountain while in labour.
“When I am giving birth, I bleed a lot so I don’t want to be carried on a stretcher [down the mountain] to the hospital. In Wli Todzi, there is no road so I have to go to Hohoe before my time is due.”
Lack of transport infrastructure
This tragic problem is due to a lack of critical transport infrastructure which will enable improved access to health centres and thus allow women to safely give birth. Without good roads, the villagers are essentially cut off from Ghana and thereby the healthcare service to which they are entitled.
Instead of risking giving birth in Wli Todzi, Zatey wisely chose to deliver her three children in Togo and Hohoe. Often times village women make the decision of giving birth in Togo because of the road connecting Wli Todzi with Kpalime, which grants them easy access to Togolese, not Ghanaian hospitals.
But this is an expensive option. It costs approximately GH¢65, including transport, to deliver in Togo.
“Even though the cost was very high, it was still the best... [At the time] I had no other choice,” says Zatey.
In Wli Todzi there are two community health nurses. However, they are not trained in midwifery, leaving pregnant women with no other option than going to Hohoe or Togo before their due date. In 2007, Wli Todzi was promised a road by the late Vice President, Aliu Mahama. Construction crews arrived, but shortly thereafter the project was abandoned.
“In 2007, we tried to construct the road ourselves when the government came in to help us and machines were brought for the construction of the road. The work started but before we realised the machines were taken away. We tried to investigate but we could not get anything out of it,” says Chief of Wli Todzi and the acting Paramount Chief of the Wli Traditional Area, Torgbe Agbenoto III.
The Ministry of Roads and Highways’ Pilot Programme Based Budget for 2013-2015 lists a feeder road from Ahor to Wli Todzi as one of its main priorities. To date, however, there are no construction crews in the area.
The Volta Regional Manager of the Department of Feeder Roads, Mr Osei Nketia, says lack of funding is making it difficult to initiate the project.
“As a lower middle income country, there is not enough money to construct the road. They are currently assessing the conditions, with the goal of creating the design of the road within two months. Following the assessment, they will determine the budget for the project to start, subject of course, to the availability of funds. When we are done with the design, I am sure that the central government will give us approval for us to award the road on contract,” says Nketia.
The Hohoe Municipal Director of Health Service, Dr Felix Doe, is not aware of anything being done about the road construction, but agrees that it is very necessary.
He says it is not easy to get a midwife to the community. “It is very difficult to get a midwife to go there [to Wli Todzi]...They don’t want to go because of the distance. If you look at the cost of travelling from Hohoe to Wli Todzi, it is a lot of money.”
Talking about the link between transport infrastructure and the number of hospitals, clinics and maternal health centres, Dr Doe said those facilities would become useless without good roads. “If you have many bad roads, those clinics will not have any use. The roads are very important. In Hohoe [district], roads are very bad, very bad.”
Delay
Furthermore, when women discover they are pregnant they often wait too long before they report to the clinic.
“Women come too late to the clinic after they get pregnant. The communities are very far, road networks are bad. Moving from the community to the clinic is very difficult.”
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Although Ghana has made significant progress on several Millennium Development Goals, maternal health is not one of them. Statistics have shown that in 2011, 350 Ghanaian women died per 1000 live births. MDG Five lists the goal as 180 deaths per 1000 live births by 2015.
Dr Sylvia Deganus, the Maternal and Newborn Health Technical Advisor of the Mama Yé Campaign, a local organisation dedicated to improving infant and maternal health, referred to transportation as one of many elements contributing to a mother’s health.
“There are many causes, the home, environment and healthcare. Transport is only one of many issues, [but it] plays a key role, we can’t do without it,” Dr Deganus says.
Maternal health is multifactorial and is one of the key indicators of development as it involves income and social status.
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“Maternal health will yield dividends. You’ll educate women, the other half of the population. It strengthens the community entirely. Having a mother is not even quantifiable; a mother’s death changes a lot. A mother’s life is precious.”
Government’s failure
According to Dr Deganus, the government has failed to allocate sufficient resources to achieve MDG Five by 2015. “To be honest, it’s going to be difficult. If we all put our shoulders to the wheel we can probably do it, but the pace it’s going doesn’t make me very optimistic.”
Patrick Gborgbortoi, 21, has carried countless women on a stretcher down the mountain from Wli Todzi.
“We have a stretcher. When you are tired, somebody replaces you. Twenty to 24 people go down with one woman. Sometimes when we get to Wli, we need to get a car. Many people lose their lives when they are waiting for the car.”
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He asks his mother if she can help him to remember the names of the women who have died being carried down the mountain and she shakes her head.
“You know these things are so horrible, they don’t want to speak of it,” he says.
“It is very difficult. Sometimes we blame our forefathers. Why do we need to experience this? But sometimes it’s the way God wants it. You send the person to the mortuary and come back...it’s not easy at all,” he adds.