Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana

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Study Justification:
– Poor access to and use of skilled delivery services contribute to poor maternal and newborn health in sub-Saharan African countries, including Ghana.
– Previous studies have focused on identifying norms of non-use of services, rather than factors that can promote service use.
– This study aims to identify strategies to overcome health system barriers to the use of skilled delivery services in Ghana.
Study Highlights:
– Primary qualitative research with 185 expectant and lactating mothers and 20 healthcare providers in six communities in Ghana.
– Strategies identified include:
1. Expansion and redistribution of existing maternal health resources and infrastructure.
2. Training of more skilled maternity caregivers.
3. Instituting special programs to target women most in need.
4. Improving the quality of maternity care services provided.
5. Improving doctor-patient relationships in maternity wards.
6. Promotion of choice, privacy, and patient dignity in maternity wards.
7. Building partnerships with traditional birth attendants and other non-state actors.
Recommendations for Lay Reader and Policy Maker:
– Expand and redistribute maternal health resources and infrastructure to improve access to skilled delivery services.
– Increase the number of skilled maternity caregivers through training programs.
– Implement special programs to target women most in need of skilled delivery services.
– Improve the quality of maternity care services provided.
– Enhance doctor-patient relationships in maternity wards.
– Promote choice, privacy, and patient dignity in maternity wards.
– Build partnerships with traditional birth attendants and other non-state actors to improve service utilization.
Key Role Players:
– Ministry of Health
– Health facilities and clinics
– Skilled maternity caregivers
– Traditional birth attendants
– Non-governmental organizations (NGOs)
– Community leaders and influencers
– Women’s advocacy groups
Cost Items for Planning Recommendations:
– Infrastructure development and improvement
– Training programs for skilled maternity caregivers
– Special programs targeting women in need
– Quality improvement initiatives
– Doctor-patient relationship training
– Promotional campaigns for choice, privacy, and patient dignity
– Partnership building activities with traditional birth attendants and non-state actors

Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor–patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor–patient relational practices that positively influence women’s healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.

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Based on the description provided, here are some potential innovations that can be used to improve access to maternal health:

1. Expansion and redistribution of existing maternal health resources and infrastructure: This could involve increasing the number of healthcare facilities and maternity clinics in underserved areas, as well as ensuring that resources are distributed equitably across different regions.

2. Training of more skilled maternity caregivers: Increasing the number of skilled healthcare providers, such as midwives and obstetricians, can help improve access to quality maternal health services. This could involve providing training programs and incentives to attract more healthcare professionals to work in maternal health.

3. Instituting special programs to target women most in need: Implementing targeted programs that focus on reaching and providing support to vulnerable and marginalized women, such as those in rural areas or with low socioeconomic status, can help improve access to maternal health services for those who need it the most.

4. Improving the quality of maternity care services provided: Enhancing the quality of care provided in maternity clinics, including ensuring the availability of necessary equipment, supplies, and medications, can help attract more women to seek skilled delivery services.

5. Improving doctor-patient relationships in maternity wards: Promoting positive doctor-patient relationships, such as through effective communication, empathy, and respect, can help build trust and encourage women to seek skilled delivery services.

6. Promotion of choice, privacy, and patient dignity in maternity wards: Creating a supportive and respectful environment in maternity wards, where women have the freedom to make informed choices about their care, and their privacy and dignity are protected, can help improve access to skilled delivery services.

7. Building partnerships with traditional birth attendants and other non-state actors: Collaborating with traditional birth attendants and other community-based healthcare providers can help bridge the gap between formal healthcare systems and communities, and ensure that women have access to appropriate care during pregnancy and childbirth.

These innovations, if implemented effectively, can help address health system barriers and improve access to skilled delivery services for expectant and lactating mothers in Ghana.
AI Innovations Description
The recommendation to improve access to maternal health based on the study in Ghana includes the following strategies:

1. Expansion and redistribution of existing maternal health resources and infrastructure: This involves increasing the availability of maternal health facilities and services in areas with limited access. It may include building new clinics or upgrading existing ones to ensure they are adequately equipped to provide skilled delivery services.

2. Training of more skilled maternity caregivers: Increasing the number of skilled healthcare providers, such as midwives and obstetricians, can help address the shortage of personnel and improve access to skilled delivery services. This may involve providing training programs and incentives to attract more healthcare professionals to work in maternal health.

3. Instituting special programs to target women most in need: Identifying and targeting women who face the greatest barriers to accessing skilled delivery services can help ensure that they receive the care they need. This may involve outreach programs, financial assistance, or transportation support to help overcome barriers such as distance, cost, or cultural factors.

4. Improving the quality of maternity care services provided: Enhancing the quality of care provided in maternity clinics can help increase trust and confidence in the healthcare system, encouraging more women to seek skilled delivery services. This may involve improving the infrastructure, ensuring availability of necessary medical supplies, and implementing evidence-based practices.

5. Improving doctor-patient relationships in maternity wards: Building positive doctor-patient relationships can help improve women’s healthcare-seeking behaviors. This may involve training healthcare providers in effective communication and empathy, ensuring respectful and patient-centered care, and addressing any power imbalances or cultural biases that may exist.

6. Promotion of choice, privacy, and patient dignity in maternity wards: Respecting women’s autonomy and preferences during childbirth can help improve their satisfaction and encourage them to seek skilled delivery services. This may involve providing options for pain management, involving women in decision-making, ensuring privacy during labor and delivery, and promoting culturally sensitive care.

7. Building partnerships with traditional birth attendants and other non-state actors: Collaborating with traditional birth attendants and other community-based healthcare providers can help bridge the gap between traditional and skilled delivery services. This may involve training traditional birth attendants in safe delivery practices, establishing referral systems, and promoting collaboration and mutual respect between different healthcare providers.

Implementing these strategies can help address the health system barriers to accessing skilled delivery services, ultimately improving maternal and newborn health outcomes in Ghana.
AI Innovations Methodology
Based on the description provided, here are some potential recommendations for innovations to improve access to maternal health:

1. Mobile health (mHealth) interventions: Develop mobile applications or SMS-based systems to provide pregnant women with information, reminders, and support throughout their pregnancy and postpartum period. This can help address barriers such as lack of information and limited access to healthcare facilities.

2. Telemedicine: Implement telemedicine programs that allow pregnant women in remote areas to consult with healthcare providers through video or audio calls. This can help overcome geographical barriers and provide timely advice and guidance.

3. Community-based interventions: Establish community health worker programs to provide education, counseling, and basic healthcare services to pregnant women in underserved areas. These workers can also facilitate referrals to skilled delivery services and provide follow-up care.

4. Transportation solutions: Develop innovative transportation solutions, such as ambulance services or transportation vouchers, to ensure that pregnant women can reach healthcare facilities in a timely manner, especially in rural or remote areas.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather baseline data on the current state of access to maternal health services in the target area, including factors such as distance to healthcare facilities, utilization rates, and barriers faced by pregnant women.

2. Modeling: Use mathematical modeling techniques to simulate the potential impact of the recommended innovations on improving access to maternal health. This could involve creating a simulation model that incorporates factors such as population demographics, geographical distribution, and the expected effectiveness of the innovations.

3. Scenario analysis: Run different scenarios within the simulation model to assess the potential impact of each innovation individually and in combination. This can help identify the most effective combination of interventions and estimate the potential increase in access to maternal health services.

4. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the results and identify key factors that may influence the impact of the innovations. This can help inform decision-making and prioritize interventions based on their potential impact and feasibility.

5. Evaluation: Monitor and evaluate the implementation of the recommended innovations in real-world settings to assess their actual impact on improving access to maternal health. This can involve collecting data on utilization rates, user satisfaction, and health outcomes to validate the simulation results and inform further improvements.

Overall, this methodology combines data analysis, modeling, and real-world evaluation to simulate and assess the potential impact of innovations on improving access to maternal health.

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