A project initiated by the Participatory Action for Rural Development Alternatives (PARDA) to ensure that mothers and their babies remain alive and well before and after delivery has led to the discovery of four Community-based Health Planning and Services (CHPS) compounds running without a midwife.

The discovery comes two years after Ghana’s Minister for Health, Kwaku Agyemang Manu, had promised the government would deploy midwives to “all CHPS compounds across the country” to address maternal and newborn deaths. The Health Minister gave the assurance in 2018 at the national launch of the International Day of the Midwife held in the Ashanti regional capital, Kumasi.

The midwife-deprived health facilities— found in the Upper East Region— include the Nyogbare CHPS Compound in the Nabdam District, the Gbani CHPS Compound in the Talensi District, the Pindaa CHPS Compound in the Kassena-Nankana Municipality and the Gane-Asonge CHPS Compound in the Nabdam District.

Starr News learns that when expectant mothers are due for delivery in those communities, they travel a long way to health centres located far outside their rural settlements. The women in Gbani travel to the Duusi Health Centre for delivery. Those in Pindaa go on exhausting, long journeys to the Navrongo War Memorial Hospital.

And whilst the pregnant women in Gane-Asonge go to the Zanlerigu Health Centre, the women in labour at Nyogbare trek to the Sakoti Health Centre for midwifery services. There are fears some mothers-to-be could resort to home-based delivery as midwives are absent in their immediate surroundings.

Meanwhile, PARDA is strongly pushing for the four CHPS compounds to be given midwives without further delay to augment Ghana’s chances of attaining the Sustainable Development Goal (SDG) 3 on maternal and infant health by 2030.

“There are some CHPS compounds that do not actually have midwife and also there are some CHPS compounds that have midwife but the performance of the midwife is not that encouraging. What we advocate is that every CHPS compound should have a maternity unit and a delivery ward. We are advocating that government should make it a policy and make sure that we have a maternity unit in every CHPS compound. We are even advocating that there should be youth corners.

“There are some places that you go and the young girls find it difficult to mingle with their ‘mothers’ when they are pregnant. It is a silent headache we have identified and have advocated with the Ghana Health Service but we don’t know how far it has gone. We want the health services to be at the typical villages to reduce the number of referrals because by the time they will get to the hospitals, with the attendant costs, complications would have set in,” PARDA’s Director, Dr Michael Wombeogo, told Starr News.

How the four CHPS Compounds came into the spotlight

PARDA is an old friend to the Ghana Health Service (GHS). The not-for-profit organisation has, from the pre-COVID-19 times to this day, continued to devote resources sourced from donors towards the wellbeing of communities in Ghana through the GHS.

And in keeping with that commitment, it also launched an initiative dubbed Citizens in Health Accountability Project (CHAP) in six local government areas (where it operates) in the Upper East Region. The six areas consist of the Bolgatanga Municipality, the Bawku Municipality, the Kassena-Nankana Municipality, the Nabdam District, the Talensi District and the Bawku West District.

That project, in line with its main objective, empowered some communities to hold authorities accountable for their health-related needs. The communities were told what a CHPS compound was all about— a structure meant to provide basic healthcare services at their doorsteps— and how to participate in efficient management of the CHPS compounds through the CHAP system.

Then, a team called Community Oversight Committee (COC) was formed in each of the target communities with a mandate to ensure that the communities (the chiefs and the people) and the authorities (the health directorate and the assembly) performed their respective duties in making the CHPS compounds function as they should.

The CHAP initiative, funded by the Open Society Initiative for West Africa (OSIWA), is being implemented through what PARDA calls Social Accountability Mechanisms (SAMs). The mechanisms comprise community scorecards, citizen reports, league tables, community durbars, platforms for multi-stakeholder dialogue and performance review sessions. It was through the implementation of the CHAP activities in the communities the four midwifeless CHPS compounds were revealed.

GHS blames unavailability of midwife on low patronage

But GHS authorities are pointing at low patronage of antenatal and midwifery services on the part of community members as a reason midwives are unavailable at some CHPS compounds in the region.

The authorities made the remarks when PARDA organised a multi-stakeholder conference in the Upper East regional capital. The meeting brought together members of the target communities and duty bearers to discuss some successes scored since the introduction of CHAP and some challenges experienced so far in respect of the citizens’ access to health services at the various CHPS compounds.

PARDA officials, GHS heads, representatives of municipal and district assemblies, traditional figures and members of the COCs took turns to present reports and responses at the conference.

“You want a midwife and you know that in this community my women are delivering in the house, you have to bring it to us. Kpatia, a midwife has always been there but when you look at their skilled delivery— so low, so low.

“If we say at Kpatia, twenty women are supposed to deliver in this facility in the month and that midwife delivers only two women in the month, it’s wasting. How would we keep that midwife there? So, these are some of the things you would have to understand with us. If the communities are ready to utilise our services, we will send our midwives there,” responded the Talensi District Director of Health, Estella Abazesi.

Adding the voice of the Upper East Regional Health Directorate to the discussions, the Upper East Regional CHPS Coordinator, Emmanuel Ansu-Abina, observed that some improvised ambulances provided by the Korean International Cooperation Agency (KOICA) had been idling away at some CHPS compounds in the region instead of being used for referral rides. After that, he urged the communities to make good use of the resources at their disposal to justify demands for more from donors.