Accountability for maternal and newborn survival - Rethinking our strategies!

Global efforts to reduce maternal and newborn deaths remain a far cry from reality, at least, according to the World Health Organisation (WHO).

A WHO factsheet on the Millennium Development Goals (MDGs) updated in May 2014 indicates that: “Despite a significant reduction in the number of maternal deaths – from an estimated 523 000 in 1990 to 289 000 in 2013 – the rate of decline is less than half of what is needed to achieve the MDG target of a three quarters reduction in the mortality ratio between 1990 and 2015.”

This statistic is indicative of the apparent lack of effective accountability mechanisms for evaluating and monitoring Maternal and Newborn Health (MNH) initiatives and strategies at the national level.

Failure of countries in Sub-Saharan Africa to address weaknesses in their health systems deepens the unremitting death sentence for pregnant women and newborns. Ghana’s health system is symptomatic of what pertains in other African countries within the region.

Despite a plethora of projects and initiatives to halt preventable maternal and newborn deaths, the problem persists. How then does a lower-middle income country with visible economic strains ensure the effective implementation of accountability measures to address preventable pregnancy-related deaths?

CoIA and Ghana’s commitments In 2010, the Secretary-General of the United Nations, Ban Ki-Moon launched the Global Strategy for Women’s and Children’s Health in a bid to save 16 million lives in the world’s poorest countries by 2015. A key component of the strategy is accountability for financial resources and health outcomes.

The Commission on Information and Accountability (CoIA) for Women's and Children's Health also known as the Accountability Commission was created to effectively implement this global strategy. The Commission subsequently came up with an accountability framework to:

• Track results and resource flows for women’s and children’s health at the global and country levels;

• Identify a core set of indicators and measurement needs for women’s and children’s health;

• Propose steps to improve health information and registration of births and deaths in low-income countries;

• Explore opportunities for innovation in information technology to improve access to reliable information on resources and outcomes.

Ghana’s maternal mortality ratio of 380 per 100,000 live births puts her among 75 countries with high burdens of maternal and/or child mortality.

Ghana pledged, as part of the CoIA commitments, to increase funding for healthcare to at least 15% of the national budget by 2015; strengthen its free maternal health care policy; ensure 95% of pregnant women are reached with comprehensive prevention of mother to child transmission of HIV service; ensure security for family planning commodities; and increase the proportion of children under-five and pregnant women sleeping under insecticide-treated nets to 85%.

These notwithstanding, Ghana’s progress towards achieving increased survival for pregnant women and babies has stagnated as a result of systemic health concerns.

Partnerships to project citizens’ voices It is the responsibility of a government to be accountable to its people due primarily to the social contract between citizens and states. However, every citizen, be it individual or corporate, has a distinct role to play in exacting accountability for the commitments and promises made to them and on their behalf.

A study conducted by the Alliance for Reproductive Health Rights in the Western and Central regions as part of efforts to improve access to quality health services for all Ghanaians through greater accountability and responsiveness in health service delivery revealed that there is low uptake of antenatal services among rural women.

The data reinforced the popular fact that attitudes of some health workers prevented women from patronizing maternal and family planning services. In view of this, an Ombudsman platform was created outside the facilities to enable community members report their encounters with skilled birth attendants.

The Ombudsman platform, albeit not new, provides a novel way of capturing grievances and culturally sensitive suggestions to improve quality of care for pregnant women. The rationale is that the report will serve as a vital accountability mechanism for health service delivery in rural and underserved communities.

Similarly, a scorecard assessment process has been implemented in the Ashanti and Volta regions by the Evidence for Action (MamaYe) project to improve Maternal and Neonatal Health (MNH) by creating accountability at the health facility and district level using an innovative mobile health data collection system.

The scorecard assessment is being used to elicit social and public accountability to increase the responsiveness of service providers to assist districts in targeting quality improvement efforts. Through the scorecards mechanism, healthcare providers will be able to assess their own output through the lens of community members.

If Ghana is going to make real progress in improving maternal and newborn survival from the Teaching Hospitals down to the compound for Community-based Health Planning and Services (CHPS), women should be able to access quality reproductive health care and effective interventions around the country.

This is possible if government progressively and rapidly increases the health budget as per its own commitments under the Commission on Information and Accountability framework.

Coordinated advocacy, coupled with political commitment and financial investment, contributes towards rapid increases in health services coverage for the vulnerable.

Ghana requires a concerted approach to intensify innovative and strategic actions that, truly, save lives. That is definitely a rewarding way to do away with preventable maternal and newborn deaths!

The writer is a Reproductive, Maternal and Newborn Health advocate (Email: d.adogla@arhr.org.gh)