Poor roads hamper attainment of maternal health outcomes

Over the last 3 decades, the Ghana government and its development partners have implemented many policy options; all geared towards addressing challenges hindering the provision of affordable and quality healthcare at the rural communities. The implementation of the Ghana Community Health Planning Services (CHPS) is one of government’s programmes addressing access, quality and equitable delivery of health services to rural communities. The CHPS programme has achieved varied degrees of successes, but challenges such as poor and inaccessible roads, lack of electricity and inadequate logistical supplies are persistently hindering the attainment of MDG 4&5 outcomes in the Northern Region.
According to the Ghana Health Service, the CHPS system hinges on the mobilization of community leadership to participate in the implementation of  the policy through volunteerism and community sensitization around primary healthcare in specified catchment areas (known as CHPS zones). Communities provide voluntary support in helping to create a conducive environment for frontline health staff (known as Community Health Officers) to deliver improved healthcare. 

SEND-GHANA recently commissioned a study on the CHPS system in 30 districts in 4 regions (Upper West, Upper East, Northern and Greater Accra regions) and the findings revealed evidence that the CHPS system has contributed in no small way towards improving maternal health. Additionally, the CHPS compounds have considerably reduced long distances previously covered by pregnant women to attend Antenatal Care (ANC) and seek other healthcare services. CHPS has also reduced the waiting period patients have to endure to access healthcare in other facilities such as the district health facility. 

The Kpandai District Health Directorate reported that antennal attendance in the Kpandai district, for instance, has improved progressively under challenging situation. Antenatal attendance increased systematically from 3,047 in 2010 to 4,538 in 2012, representing about 49% growth with far-reaching benefits to communities. A community Health Officer (CHO) in Zabzugu intimated that “pregnant women now attend ANC regularly for weighing as well as education on maternal care because of the presence of the CHPS compound and this has helped to reduce mortalities in the community”.

This notwithstanding, several challenges persistently confront the implementation of the CHPS system and threatens the sustainability of the successes choked so far. Inadequate human resource (such as midwives), inadequate or poor infrastructure, inadequate logistics poor transportation are major challenges threatening the success of the CHPS system. Monitoring by SEND-Ghana has revealed that Kpandai District has two (2) Midwives, with Nanumba South District having only one. Yendi District has three (3) midwives, who are all retirees serving on contract and the implications pose a great danger to provision of quality healthcare.

In terms of poor and inaccessible roads linking CHPS zones, the unmotorable road network coupled with lack/poor ambulance services for referral cases in rural communities such as Buya in Kpandai and Mapedo in the Nanumba districts are disturbing and alarming. 

In fact, the single ambulance in the Nanumba South District has broken down for about 6 months now, thereby posing considerable risk to pregnant women in emergency circumstances.

Inaccessible road network from Buya to Kpandai, which is the district capital (13km stretch of rough road) , resulted in the death of one pregnant woman during an emergency situation in 2012. One health worker in the Kpandai reported that “transportation in my facility is a very big challenge” which poses a lot of challenges to healthcare delivery in the facility. 

It was further revealed that “…… a woman delivered and was bleeding profusely but there was no means to transport her to Kpandai as a result she bled to death” adding that “I feel hurt and pain to lose someone in this manner because it is a death we could have prevented if there was an ambulance or if the road was good”. The sentiments expressed above reflect the frustrations of most Community Health Officers (CHO) across most districts in the Northern region face on daily basis. The case of Buya is further compounded by the lack of electricity and inadequate logistics at the CHPS zone. 

It is noteworthy that, while the District Health Directorates are working hard to ensure that health facilities get the required logistical support and other essentials, the Kpandai district assembly has pledged to extend electricity and improve the road linking the referral hospital to the health facility at Buya among others with funding from the District Development Fund (DDF). 

However, the bigger question arising is how the Department of Feeder Roads which “exists to ensure the provision of safe all weather accessible feeder roads …… to facilitate the movement of people, goods and services and to promote socio-economic development” in rural communities in the districts can effectively provide this public good for the benefit of health facilities such as the Buya health center. It is not just enough to establish a CHPS compound in a community but also to create the right environment by providing facilities such as accommodation for Health Staff, safe working environment, good roads and ambulance services to enhance safe transportation to referral centers in the districts and beyond.

Finally, SEND Ghana recommends that District Assemblies, the Department of Feeder Roads, the Ghana Health Service and other stakeholders should work in synergy to address the challenges identified and guarantee the gains made in the application of the CHPS system. The Ministry of Health need to accelerate speedily release funds set aside by president and his ministers to the construction of CHPS compounds. In addition, District Assembly Members, Unit Committees are relevant actors in providing affordable healthcare to their constituents and thus need to rise up and take the challenge of mobilization to support CHOs in the CHPS zones.

Story by John Nkaw, Programme Officer, SEND-GHANA