Mrs. Latifa Alhassan delivered her fifth child on April 19, this year, at the Karaga Polyclinic in the Karaga District and was discharged same day.

Back to her home at Nyensobga, the 29-year old mother, was surrounded by her husband, Alhassan Yakubu, and some relatives - all providing any support she needed. Mrs. Alhassan and the baby looked healthy. She was happy to have a supportive husband and relatives assisting her as she began to nurse her baby.

Mr. Alhassan always accompanied her wife to the health facility for ante-natal care. He was also on hand when she was in labour at the health facility.

He has been helping the wife to undertake household chores. Mrs Alhassan attributed the safe delivery of her child to the support she received from her husband.
Husbands’ assisting their wives to especially seek ante-natal care has become common place in many communities in the Karaga and Mamprugu/Moaduri Districts of the Northern Region.

In some communities, the decision about a woman’s health care; to visit a health facility during pregnancy has always been made by the husband.
Stories are told of instances where pregnant women suffered complications and or even died through child birth because the husbands to sanction any decision to send them to the facilities were either not at home when the women were in labour or simply refused to give their consent to delivery at a health facility.

According to the Northern Regional Health Directorate, maternal mortality in the region reduced from 115 in 2007 to as low as 19 deaths by December, 2014.
The situation took a dramatic upward trend in 2015 when the region recorded 92 maternal deaths. In 2016, a total of 130 maternal deaths were seen with 426 children aged from zero to 11 months old also dying during same period.

The government and its development partners have been implementing a number of interventions to reverse the trend. Prominent among these are the free maternal care, the training of more midwives and construction of Community-based Health Planning and Services (CHPS) compounds in remote areas to deliver essential health services to especially pregnant women.

The SHOW Project

Another intervention that is significantly contributing to the reduction maternal and child mortality in the country is the Strengthening Health Outcomes for Women and Children (SHOW) Project. The SHOW project is a 53-month gender focused maternal, neonatal and child health intervention being implemented by NORSAAC, a non-governmental organization, with funding from Global Affairs Canada.

It began in 2016 and its goal is to contribute to the reduction of maternal and child mortality in the Karaga and Mamprugu/Moaduri Districts. It is improving the utilization of essential health services by women of child bearing age, adolescent girls, newborns and children.

Added to these are the quality, availability and utilization of maternal, neonatal and child health services through health system strengthening, accountability and the promotion of gender equality in the districts.

Under the project, Boys and Girls Clubs, and Dads’ Support Clubs have been formed in communities across the two districts. The Boys and Girls Clubs are composed of adolescents. Trained volunteers teach members of the clubs reproductive health, family planning, early marriage, teenage pregnancy, ante-natal and post-natal care and how to assist one another to undertake household chores.

Members of the clubs replicate the lessons to other adolescents in the communities in an effort to spread the knowledge. The adolescents also share lessons learnt with their parents and encourage them to practice the knowledge acquired.

The Dads’ Support Clubs are composed of men and they are taught to assist their wives to undertake household activities, help them during pregnancy by following them to health centres for ante-natal care, during child delivery and post-natal care.

This strategy is meant to promote behavioural change, especially among men so that they give strong support to their wives during pregnancy - send them to the health facilities for quality care. This ultimately, would result in a decline in maternal and child deaths.

Testimonies from Communities

Zakaria Wumbei Musah, chief of Zandua community in the Karaga District said the activities of Boys and Girls Clubs, and Dads’ Support Clubs under the SHOW project had brought tremendous benefits to his community - men were now collaborating with their wives to promote the welfare of their families.

It was now a normal practice, seeing men providing their pregnant wives with every help they needed – accompanying them to health centres.

The chief said to get women to deliver their babies at the health centres, he had instituted sanctions against any woman who delivered in the house and added that, since 2017, not a single woman had given birth to a child at home.
Alhassan Issah Wumpini, assembly member for the Nyensobga electoral area in the Karaga District, said the SHOW project, apart from enlightening men to assist their pregnant wives was also helping to reduce conflicts in homes.

The families were increasingly making contributions to the “Savings and Loans Associations” in the villages and that was giving them access to credit to expand their economic activities - to take care of their needs and thereby promoting healthy homes.

Miss Abu Rafia, a member of the Girls Club at Kikaayiri in the Mamprugu/Moaduri District said through the SHOW project, adolescents in the district were now aware of signs and symptoms of adolescence and how to handle things to prevent teenage pregnancy, maternal and child mortality.

Testimonies from health staff
Miss Rashida Salifu, Community Health Nurse at Namoo CHPS compound in the Mamprugu/Moaduri District said “in the remote areas where I work, it was difficult for a man to accompany a woman for ante-natal care, child delivery and post-natal care but due to the SHOW project, we get the same number of male involvement as the number of child deliveries”.

She added that previously, “when we had about 30 deliveries, male involvement was only one or two”.

“Skilled delivery is increasing - they used to deliver at home with the help of Traditional Birth Attendants (TBAs) but the SHOW project also trained TBAs as link providers, who also refer cases to facilities for skilled deliveries.”

Mr. Haris Alhassan, male Midwife at Kubori Health Centre, spoke of how the district used to record high teenage pregnancies – with illegal abortion and unsupervised deliveries, leading to complications and deaths.

In the past, during child welfare clinic, “we recorded a number of teenage mothers but it has reduced now due to activities of the SHOW project”.

He said the sharing of the knowledge by adolescents with their parents had also led to increased facility deliveries adding that at the Kubori facility, they were recording about 40 deliveries every month. That previously was not the case.

Mr. Abdulai Baba Yakubu, Disease Control Officer at Karaga South sub-District Health Office, said “the SHOW project has helped to improve most of our indicators especially ante-natal care,” adding, the community members always refer cases to health facilities.

Miss Anis Ajein, Midwife at Zandua CHPS compound said the project had been highlighting the dangers associated with unsupervised delivery.

Challenges

Even though efforts are being made under the project to convince women to seek ante-natal care, child delivery and post-natal care at the health facilities, few others continue to patronize services of the TBAs.

Evidence also abound that there are some men, who do not consider it necessary to stay by the side of their women when it comes to not only maternal and child health care but decision making in the house.

At facility level, provision of adequate logistics including child delivery kits, consumables and non-consumables remains a challenge. They are always struggling with inadequate supplies to take care of the increasing cases in the two districts. This situation could mean unsatisfactory or poor quality health care, which could discourage people from patronizing the health facilities and that would be a drawback on efforts at reducing maternal and child mortality.

Sustaining the gains

The activities of Girls and Boys Clubs and Dads’ Support Clubs under the SHOW Project had proven to be an important strategy to achieving behavioural change necessary to bring down maternal and child deaths.

The Karaga District recorded 118 maternal deaths in 2015. This figure, however, reduced to 51 in 2016 making it one of the areas where maternal deaths were controlled.

This achievement came on the back of the SHOW project. More should be done to regularly train members of the clubs to ensure that they impart useful knowledge to people their communities – aid the people to appreciate the need to encourage their wives to go for maternal health services to save themselves and their new born babies.

As access to maternal health services at health facilities increases, it is important that the government adequately resourced, especially the CHPS compounds – give them the basic logistics to enable them to function properly.
This will inspire members of the communities, particularly pregnant women to always seek care at the facilities instead of going to the TBAs and risking their lives.

TBAs must also be trained to refer all cases to the health facilities instead of attending to them at home.

Available statistics show that maternal and child health care has improved in the country over the past two decades albeit at a slow pace. There is the need to up the effort to make sure that Ghana attains the Sustainable Development Goals (3).