Free maternal care - matters arising

Article: Salome Donkor (daily Graphic, page 11. 12th August, 2008)
THE recent grant received from the British government to provide free maternal care was hailed from various quarters as a positive step to ensure that all pregnant women in the country would pass through pregnancy and delivery safely.
The grant brought about the introduction of a policy of free medical care for pregnant women under the National Health Insurance Scheme, which started in July, this year.
The policy was announced by President J. A. Kufuor after a trip to the United Kingdom, where the British government pledged £42.5 million to support efforts at reducing maternal mortality as envisaged in the Millennium Development Goals (MDGs).
A visit to some health facilities in the Greater Accra Region ,barely 10 days into the implementation of the free access to maternal health services in the country, indicated sharp increase in the number of pregnant women registering with the National Health Insurance Scheme (NHIS) in some major hospitals.
At the Korle-Bu Teaching Hospital, a total of 780 women had registered with the scheme, 398 at the Tema General Hospital while 64 at the Prampram Healthcare Centre, when the NHIS team visited these facilities.
At its 4th National Executive Council (NEC) meeting held in Tamale between July 25 and July 27, 2008, the Ghana Medical Association (GMA), reportedly added its voice to commend the government for introducing free medical care for pregnant women to reduce maternal mortality.
The maternal mortality ratio indicates the risk of death a woman faces with each pregnancy. In settings with high fertility, such as sub-Saharan Africa, women face this risk many times in their lifetime. In Ghana, the maternal mortality ratio is estimated to be between 214 and 540 per 100,000 live births annually.
As such more women have realised the need to access available health facilities in order to have safe delivery . Health experts enumerate causes of maternal mortality in Ghana as bleeding before and after delivery, hypertension and fits in pregnancy, miscarriage and serious infection, among others.
It is therefore a little wonder that reports from various health facilities across the country indicate that the facilities have been crowded with pregnant women, following the implementation of the free ante-natal care delivery policy.
At his turn at the meet-the-press series organised by the Ministry of Information and National Orientation in Accra recently, the Chief Executive Officer (CEO) of the National Health Insurance Authority (NHIA), Mr Ras Boateng, was reported to have said that figures received from some of the districts indicated that the Ashanti Region was leading with 12,164 pregnant women who have registered under the scheme, followed by the Greater Accra Region with 8,211; the Central Region, 6, 843; the Eastern Region, 5,870; and the Western Region, 5,012.
The rest are the Upper West Region, 3,608; Northern Region, 2,720; Upper East Region, 2,473; Brong Ahafo Region, 2,434; and the Volta Region, 1,589.
The CEO was reported to have stated that there was the possibility that many of those women would not have gone for ante-natal care if the policy was not introduced. This is quite valid considering the fact that, before the introduction of the policy, some women who could not pay for the costs of their delivery were detained by the hospitals.
Under this programme pregnant women would benefit from the ante-natal period to three months after delivery, while emergencies during delivery and all other medical problems that would arise within this period would be covered.
Reports from the Korle-Bu Teaching Hospital, the nation’s premiere hospital indicate that following the implementation of the free ante-natal care, the number of delivery cases each day has increased to about eight times and also there is also 12 to 50 caesarian sections each day.
Inaugurating a second theatre for the hospital’s Obstetrics and Gynaecology Department, Prof Enyonam Yao Kwawukume ,was reported to have said that the implementation of the free ante-natal care had increased the attendance of pregnant women to the hospital.
He explained that consequently, hospital staff had to work extra hard to attend to the increased number of patients, some of whom needed emergency obstetric and gynaecological care.
It is obvious that a measure needs to be put in place to address the expected upsurge in the number of maternal cases at hospitals following the introduction of the government’s free delivery services to enable the country to achieve the desired objective.
A statement jointly signed by the President of the Ghana Medical Association , Dr Emmanuel Adom Winful and the General Secretary, Dr Sodzi Sodzi-Tettey, spoke about the need for other factors to be considered to making the project meaningful and mentioned some of the factors as inadequate number of health professionals, lack of health facilities and low level motivation for health professionals in the face of increased client-load and responsibilities.
The report by the GMA which called on the government to invest resources both in the training of health professionals and the provision of basic equipment to the maternity units of the country’s health facilities to enable them to deliver efficient services, is quite timely.
Yaa Yaa, a 30-year old woman who delivered recently at the Korlebu Teaching hospital, spoke about inadequate facilities, such as beds and serious congestion at the Maternity Ward. She said the health staff are also overwhelmed by the increasing number of expectant mothers who must be attended to at the wards.
The recent opening of a second theatre for the Obstetric and Gynaecology Department of the Korle-Bu Teaching Hospital is a step in the right direction since the department used to have only one theatre that was operative.
Realising the fifth Millennium Development Goal (MDG), which commits the international community to reducing, by three-quarters, between 1990 and 2015, the maternal mortality rate in all developing countries, is an arduous task.
There is the need for the government and benevolent organisations and individuals to help realise this goal.
We are in the political season and all those who have the interest of women at heart, expect those aspiring for political positions to present their health policies as contained in their manifestos to the people and outline measures they intend to put in place to realise the MDGs with particular reference to reducing maternal mortality.
Men also have equal roles to play to live up to their parental responsibility to support government’s efforts of providing a universal access to reproductive health services.