Adwoa Kesewa is 19-years-old. She has to drop out of Junior High School(JHS) when she got pregnant. Her 21-year-old boyfriend Kwesi Prah also a school drop-out, suggested abortion, but Adwoa refused, citing the fear of death and the fact that she has heard if things went wrong she might never be able to conceive in the future.
In anger and frustration, he warned her sternly to stay away from him if she keeps the pregnancy as he is in no position as a truck pusher to support her and the baby. “You should not even mention me as the one responsible for your pregnancy! You are on your own now,” he growled. Kwesi bare survives on his meagre income as a truck pusher at one of the markets in Accra to be able to support a mother and a child.
“You said you loved me, and you will never leave me. But you are now turning your back to me, is this my reward for all that I have done for you?,” Adwoa muttered with tears streaming down her cheeks.
Adwoa’s story is common in urban and rural Ghana, where young people without sufficient sex education, with little or no vocational training and no jobs become parents when they are not ready.
With no regular sources of income or sufficient funds they are unable to acquire ante-natal care, and the pressure on the national budget for health, especially as malaria management takes a large chunk of the resources other areas within the health sector are deprived of funds.
In 2009, Ghana’s Minister of Health at that time, Dr. George Sipa-Adjah Yankey said the government spends over $760 million every year treating malaria.
The amount used in treating malaria is almost the entire budget for the health sector. In the 2009 budget for instance, an amount of over GH¢921 million was allocated to the health sector. What that means is that very little is left of the budget to treat other diseases.
The British government intervened by providing funds for maternal health care in Ghana.
In 2008 the British government provided a grant amounting to £42.5 million to support a government programme to provide free maternal health care for women. The programme is aimed at reducing the country’s maternal mortality ratio by three quarters before 2015.
In 2003, Ghana’s maternal mortality ratio was high. The country was recording one death per every 35 women during pregnancy or child birth. A World Health Organisation (WHO) report put the maternal mortality ratio in the country at 540 deaths per 100,000 live births.
But before the inception of the free maternal health care programme in Ghana in 2008, the World Bank funded the National Health Insurance programme in 2006, through which the country made a strong effort to extend health insurance coverage to people employed in the informal and rural sectors. More than half of Ghana’s population is now covered, according to the World Bank.
About 70 percent of the insured, including children and pregnant women, are exempt from paying premiums. The 2009 Demographic and Health Survey (DHS) shows at least 90 percent of pregnant women use antenatal care services, and births attended by skilled health staff rose from 40 percent (1990) to 59 percent (2008).
Following the beginning of the free maternal health care programme, Ghana received commendation from the United Nations Population Fund (UNFPA).
The Executive Director of the UNFPA, Ms Thoraya Ahmed Obaid, said it was good that Ghana introduced the programme as a way to control the high maternal mortality rate in the country in efforts to meet the Millennium Development Goals (MDG5), which aimed at improving maternal health.
She was cited in a report by the Ghana News Agency (GNA) as saying: “This means if the programme is well sustained, all pregnant women, right at the community level would have access to free maternal health care, thus preventing a woman from dying from childbirth”
However, there have been calls for more to be done to make the programme sustainable and some challenges have been identified.
One of major challenge facing the programme is ironically low patronage of antenatal care in some health facilities in Ghana.
According to a GNA report the low patronage of antenatal care and normal delivery care services at the lower level health facilities in Ghana could affect the sustainability of the free maternal health services.
The report citing Dr Emmanuel Ankrah Odame, head of the Public Health Division of Ridge Hospital said cost of free maternal services have been consistently higher at high level facilities putting so much stress on the British grant meant to improve financial access to maternal services.
Dr Odame said in order to reduce Ghana’s maternal mortality rate from the 451 per 100,000 live births and meet the Millennium Development Goal 5 (MDG5) by 2015, there was the need to sustain the free maternal health services and ensure that people access the lower levels of health facilities.
According to him, when the pressures put on the high level hospitals are not lowered the facilities in the southern center of the country alone could exhaust the British Grant in 13 years.
Dr Odame, according to the report therefore, recommended the placement of specialists in the lower facilities to attend to clients, saying, “this will let pregnant women access the lower level facilities and not use the issue of no specialists as an excuse.”
Despite the challenges however, available research data shows that Ghana has made tremendous strides in curtailing maternal and child mortality.
An estimation taken in 2001 showed that maternal deaths in the year 2000 stood at 740 per 100,000 live births.
However, the 2010 World Health Organization Report shows that maternal mortality has reduced to 560 per 100,000 live births in the country.
These achievements couldn’t have been possible without international assistance, looking at the fact that other areas within the health sector are competing for scarce resources. And young women like Adwoa, would have become part of the statistics without the free maternal health care programme.
As the world gathers in Busan, South Korea in November for the 4th High Level Forum on Aid Effectiveness to discuss the Paris Declaration and Accra Agenda for Action (AAA), Ghana’s success in the area of maternal health care which has been implemented with funds from international donors can be showcased as a success story of aid effectiveness.
By Emmanuel K. Dogbevi