Safe motherhood in Ghana: still on the agenda?

Abstract

Objective: This paper is an exploration of health sector and programming issues that resulted from a description of safe motherhood activities in Ghana. Methods: Descriptions of safe motherhood programmes were collected from various stakeholders through structured interviews. The characteristics of the programmes were compared to national safe motherhood aims and in the context of the reproductive health and sector-wide environment in Ghana. Results: Thirteen safe motherhood programmes were described. Their goals were wide ranging and did not necessarily target pregnant and postpartum women only. Community based interventions were slightly less dominant than service provision activities. A broad funding base was identified, strongly represented by external donors. Many funding contributions were not part of the Ghana government's Sector-Wide Approach (SWAp) to health. Conclusions: Although reduction in maternal mortality ratio is a priority in Ghana's policy, many funding agencies supporting what are known as "safe motherhood" programmes are actually pursuing a somewhat broader reproductive health agenda. The evidence that this situation has actually led to a dilution of the maternal mortality reduction agenda is inconclusive, although our analysis has resulted in lessons which could be used to avert any risk to achieving this key millennium development goal. Government can use the SWAp to keep interests focused on the need for maternal mortality reduction, without detriment to other priorities. Strengthening partnerships will allow civil society and community focused interests to have a voice in influencing SWAp agendas. Good programme design with clear understanding of the link between programme components and objectives will help in making sure that maternal mortality targets are indeed achieved.