Ghana: Improve Neonatal Care to Achieve MDG Four

Bolgatanga — In Ghana, reports on the nation's progress towards the achievement of the health targets of the UN Millennium Development Goals (MDGs), particularly Goal 4 which looks at reducing child mortality, could best be described as mixed. With current data registering 74/1000 for under-five mortality, 50/1000 for infant mortality, and 23 000/year for neonatal deaths, many are calling for some drastic measures.

However, the Medical Director of the Bolgatanga Regional Hospital, Dr Peter Baffoe, says the clue to achieving the MDGs target of reducing by two-thirds under-five mortality by 2015 lies within improvement in neonatal health or newborn care. Neonatal state in child health, as Dr Baffoe defined it, refers to the first minute to the 28th day of life. According to him, this is the most crucial stage of life where all the care which is needed to save a child from dying must be given.

Dr Baffoe, speaking on behalf the Regional Director Health of Services at the opening of a three-day training workshop for midwives on neonatal resuscitation in Bolgatanga in the Upper East Region, said over the years Ghana has made significant improvement in overall child mortality.

The neonatal workshop forms part of a set of interventions aimed at building the capacity of district and community health care providers under the Ghana Essential Health Intervention Programme (GEHIP) which is being piloted in the Bongo, Builsa and Garu-Tempane Districts in the region.

He said, however, if the data was desegregated one would realise that about 40% of all deaths in children occured at the neonatal state when these figures were further scrutinised. It revealed that a larger proportion of these deaths happened in the first 24 hours and or the first one week. This meant that the country needed to organise refresher training courses for midwives to keep them abreast of current standards in neonatal care.

Dr Baffoe, a gynaecologist and an advocate for universal access to reproductive health, argued that the situation of child mortality as it pertained in Ghana gave a clear indication that if the country was determined to meet the MDGs target on child mortality, then it must find solutions to the challenges of newborn care.

He stressed the merits of medical staff refresher training courses, saying the midwives, who have benefited from the first-level training on neonatal resuscitation, have become great assets to the region, their districts and communities, and the nation as whole. He commended the GEHIP project for the initiative and resources and hoped that resources would be made available to roll out similar training in all districts. He appealed to the government and health development partners to make it a priority to provide basic new born care facilities in health institutions at all levels.

A facilitator of the neonatal resuscitation training course, Dr Okai Brako, explained that neonatal resuscitation was the process of helping babies who experienced difficulties in breathing soon after coming out to be able to breathe. He noted that 10% of all babies born usually required resuscitation due to many factors such as delayed labour, among others things.

Dr Brako, who is the Head of the Neonatal Intensive Care Unit at Ridge Regional Hospital in Accra, lamented that a number of the babies usually end up dying as a result of lack of skilled personnel and equipment for resuscitation. He was hopeful that with the emergence of training modules such as the Health Babies Breathe module designed by the American Academy Pediatrics, the needed planning and resource efforts would be made for rapid transfer of the knowledge across the country for midwives to save the lives of more babies.

In an interview with this reporter, a member of the GEHIP implementation team at the Upper Regional Health Directorate, Mr Robert Aligiriya, said the entire GEHIP project was a health system strengthening strategy containing a number of well-tested and proven health interventions whose implementation and evaluation are seeking to assess the impact of comprehensive package of health interventions on the acceleration of the health MDGs.

The project, he stated, was a Ghana Health Service and the Tanzania Health Services partnership, with funding from Doris Duke Foundation, a US charity, and with technical support from Columbia University.

Mr Alerigiya explained that the GEHIP sought to change the trends in resource allocation through the use of a planning tool call the District Health Planning and Reporting Tool-kit (DiHPART). The tool helps prioritise resource application based on locally obtained burden of disease data.

The planning process settles the old riddle of budgeting. The programme also emphasises the increase in access of integrated primary health care services through the scaling up of the Community-based Health Planning and Services (CHPS) programme. Other components of the GEHIP include improvement in health information management, district leadership capacity and self development.