Promoting accountability and action at the health facility level

Transcription

1 Promoting accountability and action at the health facility level Client-community-provider partnerships to improve maternal and newborn health services in Ghana Lucy B. Ofori-Ayeh, University of Ghana

2 Presentation Outline Overview of the Ghana MNH context The E4A Programme The Scorecard Process Evidence Generation Results: Processes and Outputs Sustainability Conclusions and Recommendations

3 Overview of Ghana MNH situation Maternal Health Newborn Health Human resources and access to MNH services Maternal Mortality Ratio: 380 (per 100,000 live births) MDG target: 190 Neonatal Mortality Rate: 29 (per 1,000 live births) 39 midwives per 200,000 population A woman in Ghana has a 1 in 66 lifetime risk of dying from a maternal cause 63 newborns die every hour during childbirth ( every year) 53 midwives per 200,000 would be required to meet the national target Main causes of Maternal Deaths: haemorrhage; abortion; eclampsia; miscarriage; sepsis; obstructed labour. Main causes of death: prematurity, infections and birth complications including asphyxia Large access discrepancies between rural and urban areas Sources: Countdown 2015, WHO et al 2014; DHS 2014, UNICEF et al 2014, MoH 2011.

4 The E4A Programme in brief Evidence for Action (E4A) to Reduce Maternal and Neonatal Mortality in Africa [ ] UK Department for International Development (DFID) University of Ghana, Alliance for Reproductive Health Rights Ghana, Sierra Leone, Nigeria, Ethiopia, Tanzania, Malawi National Level 4 Regions: Greater Accra, Volta, Ashanti, Upper West Swiss TPH, Options Consultancy (UK), South Hampton University (UK) Overall Programme Aim Improve maternal and newborn survival by using evidence in a strategic way to generate political commitment, strengthen accountability and improve planning and decision making at subnational and national levels Objective 1 (of 5) Improving quality of care at MNH health facilities through clientprovider-community partnerships and forums.

5 Client-Community-Provider Partnerships & Scorecards AIMS Improve the quality of Maternal and Newborn Health Services in health facilities Engage all actors that have a stake in Maternal and Newborn Health including community representatives Produce and disseminate data that is relevant and understandable to all Engage all actors to discuss the findings and suggest redress solutions Health professionals ACTORS / PARTICIPANTS District Health Management Teams (DHMT) 37 facilities (8 districts) Community based organisations (CBOs) Create accountability through community awareness of issues and benchmarking between facilities and districts District Assemblies (DA - (traditional authority) MNH councils

6 Client-Community-Provider Partnerships & Scorecards A multi stakeholder team (4) 1 DHMT member 1 CBO representative 1 MNH council member 1 DA member (district planning office) Assessment of MNH service provision in each facility 6 monthly assessment Use of tablets Interface meetings with a broad group of stakeholders at district and facility level Scorecard results finalised and published Dissemination of findings at community, facility, district, regional and national level Next Assessment

7 Evidence Generation within the scorecard process 1. Scorecard data (6 monthly) 2. Monitoring of action forms 3. Prospective Policy Study (qualitative)

8 Results: Example Scorecard of a facility

9 Results: Example Action Plan (interface meeting) Interface meetings at district level

10 Results after the second round Issues that were addressed between round 1 and 2: 1. Signs for ANC and FP outside facility 2. Sterilizer 3. Autoclave 4. HIV test kits 5. Lamp for operations 6. Towels/blankets for newborns 7. Magnesium Sulfate 8. Better access to information

11 Results and processes A few examples of actions following the scorecard process: After hearing about client experiences in the scorecard results, one community raised money to buy chairs for waiting areas in the facility so pregnant women did not have to stand or sit on the floor (Ashanti region) A local advocacy coalition, raised money for an ambulance 50% from the community and 50% from the District Assembly. A Member of Parliament then stepped in to fund it, and the money was kept for repairs (Ashanti region) DHMT using scorecard evidence on lack of midwives to back up requests for help from Regional leadership to address the situation Source: Clark S (2014) Sub-National Policy Study Bi-annual Report: Ghana.

12 Staff of the Dwease Health Centre, community leaders and DHMT after a dialogue meeting on the ambulance repairs- District Director of Health in Asante Akyem Central mobilising funds for the repair of the Ambulance

13 Benefits of the Client-Community-Provider Partnership Scorecards make it easier for stakeholders to voice out on their concerns and act Promotes collaboration and partnership Clarifies responsibilities Helps decision-makers have a bird s eye view of the situation of a facility I think the problem about MNH is not much about financial resources but the commitment at various levels including the communities (MNH Council member) Fosters a non-blame environment (focus is on finding a solution) Source: Clark S (2014) Sub-National Policy Study Bi-annual Report: Ghana.

14 Main challenges with the participatory approach Delays in decision-making processess of government can demotivate community initiatives Heavy workload in some health facilities prevents health workers from engaging with the communities and Districts in a meaningful way Low commitment from some facilityin-charges or district officials Source: Clark S (2014) Sub-National Policy Study Bi-annual Report: Ghana.

15 Sustainability of the approach Simplifying the scorecard process and advocating for its integration into the District Health Information Management Systems (DHIMS) Strengthening the community participation component within regular processes of DHMTs The role of the MNH council concerning scorecards in the future cannot be underestimated as the results cannot work on its own. We have to take the results up and further disseminate to the community level (MNH Council member). Source: Clark S (2014) Sub-National Policy Study Bi-annual Report: Ghana.

16 Key recommendations Careful planning and involvement of stakeholders from the start (national to local level) Strengthen community voice within already existing health system and community structures Take into account sustainbility thinking from the start Involve people who have the power to improve processes and systems Benchmarking facilities and districts can promote healthy competition and improvements in health service delivery

17 Thank you

18 References Ministry of Health [Ghana] & Ghana Health Service. (2011). National Assessment for Emergency Obstetric and Newborn Care. Accra: Government of Ghana. United Nations Children s Fund, World Health Organization, The World Bank, & United Nations Population Division. (2014). Levels and Trends in Child Mortality Report 2014: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York: UNICEF. World Health Organization, UNICEF, UNFPA, The World Bank & the United Nations Population Division. (2014). Trends in Maternal Mortality: Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: WHO. Ghana Statistical Service, Ghana Health Service, and ICF Macro. (2009). Ghana Maternal Health Survey Calverton: GSS, GHS, and Macro International. Shiffman, J. Issue attention in global health; the case of newborn survival. Lancet (9730) MamaYe Scorecards Guide, 2014 Clark S. Sub-National Policy Study Bi-annual Report: Ghana. (2014)