An Open Letter to Ghana's First Lady, Mrs Rebecca Akuffo-Addo: Adoption of a Strategic and Comprehensive Approach to Maternal and Child Health Programming in Ghana

July 6, 2017

Your Excellency,

I am most delighted to hear of your decision to take on the mantle of saving Ghana's mothers and babies. Like many Ghanaians, I am disheartened by the situation at the maternity unit of the Komfo Anokye Teaching Hospital (KATH)- the situation which gave you the impetus to raise funds for the construction of a new mother and baby unit for this hospital. I appreciate the fact that this dire situation requires urgent attention and I commend you for your efforts to address this.

As a public health professional with maternal health experience in Ghana and also as a recipient of obstetric care in Ghana, I tend to gravitate towards issues that impact maternal and child health in our beloved country. Based on this interest, I am writing this letter to draw your attention to the broader underlying contextual factors that translate into poor maternal and child health outcomes in our country. I am doing this in the hope that it will inspire you to extend your efforts beyond improving infrastructure and equipment at KATH and other referral facilities, to addressing these broader systemic contributors to crises such as this.

There is no doubt that there has been progress in improving maternal and child health in Ghana over the past decades, yet much work remains to be done in this area. This is reflected in Ghana’s performance in Millennium Development Goals (MDGs) 4 and 5, which focus on child health and maternal health respectively.

The United Nations Inter-agency Group for Child Mortality Estimation’s Report (2015) indicates that Ghana experienced a decline of about 51% in under-five mortality rate but failed to attain the target for this indicator, which was to reduce under-five mortality rate by two-thirds between 1990 and 2015.

Despite failing to meet this target for MDG 4, Ghana could be categorized as making progress in reducing under-five mortality. Ghana’s performance in MDG 5 was less impressive: based on estimates from the Maternal Mortality Estimation Inter-agency Group’s report, the country experienced a decline of approximately 49.7% in Maternal Mortality Ratio (MMR) over the same time span but fell significantly short of the target of reducing this rate by 75%.

Sadly, Ghana did not only fail to attain this target but also failed to meet the criteria for “making progress” and was categorized as “making insufficient progress” in achieving MDG 5 (WHO, Trends in Maternal Mortality, 2015).

These national estimates, however, fail to give a detailed picture of disparities in maternal and child health in Ghana, which result from inequitable access to good quality care. The deaths of mothers and children at KATH as described in various news reports, though unacceptable, can be aptly described as the tip of the iceberg. The burden of maternal and child deaths is greatest among less privileged communities in underserved areas where individuals lack empowerment to make the right decisions on seeking healthcare and where myths and cultural norms affect health seeking behavior.

Pregnant women in such settings, who make the decision to seek care have to undertake long and arduous journeys often on impassable roads and if fortunate to arrive alive at a health facility, may find themselves in a facility that is poorly staffed or ill-equipped to respond appropriately to preserve their lives.

Apart from making investments in infrastructure and equipment, improving maternal and child health in Ghana, will additionally require strengthening of the other key components of the health system: leadership and governance, health information systems, healthcare financing, essential medical products, service delivery, referral systems and the health workforce. Experts have cautioned that as healthcare utilization increases and more women deliver in our health facilities, we stand a risk of experiencing poor health outcomes if quality of care is not ensured (Souza et al, 2014).

Ghana has an opportunity to learn from and build on the experiences of other low and middle-income countries that were successful in achieving MDGs 4 and 5 and a treasure trove of well-documented case studies exist on these countries. An examination of the strategies adopted by successful countries indicates that accelerating progress in reducing maternal and child mortality requires a strategic, multifaceted and data-driven approach.

Another crucial and common element among successful countries is political will and leadership and this is where I see an opportunity to leverage your proximity to the presidency and your passion for women and children's health and wellbeing.

As reflected in the recently formulated Sustainable Development Goals (SDGs), the most effective approach to improving health is by strengthening the health system within a framework of socio-economic development. The health system can function most effectively within the context of improved water and sanitation, a reliable and efficient energy supply and adequate roads and transportation. A failure to adopt a systematic and holistic approach to improving maternal and child health outcomes will likely result in a failure to yield results from huge investments including funds raised through your current efforts and a recurrence of the unfortunate situation at the maternity unit of the Komfo Anokye Teaching Hospital.

Utilizing a health system strengthening approach will not only positively impact maternal, child or reproductive health but will “ensure good health and well-being for all at all ages” (UN, SDG 3).

I am confident that our policy makers, public and private health sectors, academic community, development partners and civil society organizations who work tirelessly to address the gaps in maternal and child health, will welcome you and our president’s leadership in this area.

It is my hope that in 2030, when the global health community meets on the world’s stage to examine the extent of attainment of the Sustainable Development Goals (SDGs), Ghana would be touted as a success story.

Again, I applaud you for heeding the cry of mothers, infants and staff of the Komfo Anokye Teaching Hospital and I hope you will give consideration to this appeal to ensure that your efforts achieve sustainable results.