Geographical access to care at birth in Ghana: a barrier to safe motherhood
Gething, Peter W., Amoako Johnson, Fiifi, Frempong-Ainguah, Faustina, Nyakro, Philomena, Baschieri, Angela, Aboagye, Patrick, Falkingham, Jane, Matthews, Zoe and Atkinson, Peter M. (2012) Geographical access to care at birth in Ghana: a barrier to safe motherhood. Southampton, GB, ESRC Centre for Population Change, 34pp. (Centre for Population Change Working Paper, 21).
Background: appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa.
Methodology and findings: we assembled detailed spatial data on health facilities, roads, rivers, and other landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care at birth. We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from any facility likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios.
Conclusions and significance: detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve
|Item Type:||Monograph (Working Paper)|
|Keywords:||obstetric care, maternal mortality, geographical access, geographic information systems, Ghana|
|Subjects:||H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
|Divisions:||Faculty of Social and Human Sciences > Social Sciences > Social Statistics & Demography
|Date Deposited:||23 May 2012 09:12|
|Last Modified:||22 Apr 2015 08:19|
Centre for Population Change: Understanding Population Change in the 21st Century
Funded by: ESRC (RES-625-28-0001)
Led by: Jane Cecelia Falkingham
1 January 2009 to 31 December 2013
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