TBAs enhanced role in maternal, child health delivery

They are simply selfless in their work to deliver new babies to mother earth. They are just dedicated and committed to what they do.

Although their roles are primarily voluntary and indispensable to health delivery, they are often sidelined and neglected. Yet they exist and work in inaccessible remote areas where the aura of orthodox medicine cannot reach.

That their existence predates the establishment of modern orthodox medical practice makes them a ready, quicker and trusted intermediaries people gladly visit, consult or count on, in terms of deliveries, especially in areas of unreliable means of transports, poor road networks and where the cost of transportation to the nearest health centre was beyond the means of the people.

The Traditional Birth Attendants (TBAs) are but a priceless human resources whose contributions are yet to be fully recognized, tapped and rewarded.

The depth of their understanding of delivery, their sense of urgency to act and their willingness to support mothers have resulted in the deliveries of many babies and the death of many potential leaders and women.

However, the recent training of some 140 TBAs in parts of the Brong Ahafo, Ashanti and the Northern Regions of Ghana has shown their readiness to learn and sharpen their skills as well as collaborate and complement effectively with efforts by health institutions to ensure safe deliveries of babies.

As a result of the training, the TBAs have been  stirred  to do more to improve upon maternal and child’s health in these areas.

The training programme, according to Mr. Peter K. Yeboah, Director of Health Services   in the Catholic Diocese of Goaso, was conducted by the National Catholic Health Service in partnership with some institutions of the Christian Health Association of Ghana (CHAG), and sponsored by  Cordaid-The Netherlands.

A recent study tour of some TBA training sites at Hwidiem and its catchment area in the Asutifi South District; Abease and Yeji and their environs in the Pru District, all in the Brong Ahafo Region, as well as Kayereso and Nalerigu in the East Gonja and East Mamprusi Districts respectively in the Northern Region, has shown the encouraging contributions the TBAs were making to skilled deliveries and reduction in maternal and child morbidities.

Available data at the collaborating health facilities the TBAs were working with indicates a sharp increase in the antenatal (ANC) and   postnatal (PNC) attendance, increased referrals from the TBAs and increased supervised deliveries, as well as a reduction in maternal and child mortalities.

Records at the St. Elizabeth Catholic Hospital, for instance, where the training programme was first conducted for 28 TBAs in 2009, shows a sharp increase in referrals of pregnant women to the hospitals, which has led to increases in ANC and PNC attendance and deliveries after 2009.

Background

It was observed between 2006 and 2007 that antenatal attendance at the St. Elizabeth Catholic Hospital has plummeted from 7000 to 6000, with amenable increases in maternal mortalities, at a time maternal healthcare services was available, accessible and affordable.

Mr. Yeboah said that the situation prompted a survey, which revealed that more pregnant women at the time were patronizing the services of TBAs, and noted that the problem had to do with cultural acceptability of the maternal health services.

It was further discovered that the TBAs who were barriers to, and gatekeepers of pregnant women accessing maternal services were for instance using their bare hands in deliveries and giving local oxytocin (toxic herbal concoctions) to pregnant women to induce labour, which were in a way contributing to more community maternal and infant morbidities.

Among some communities for instance, the belief that pregnant women should by all means be touched by TBAs before they gave birth or even go to the hospital created a barrier for pregnant women not to attend ANC at the hospitals even though the services rendered to them were free, accessible and affordable.

Mr. Yeboah said the Catholic Diocese of Goaso, based on social justice and equity principle of the Catholic Church’s Social Teaching and the geographical context the Diocese found itself, started the training for TBAs in 2009 as partners to help improve upon maternal health delivery, at a time Ghana Health Services had directed its facilities not to deal with the TBAs.

With variation in development index of the country the Director of Health Services noted that “we will never have a situation where midwives will be located in every village, so the TBA is relevant and will always be relevant,” adding that “they are needed as part of public health care to mobilise their community to take care of their own health”.

“The TBAs are local assets. They are change agents, that ought to be recognized, trained and repackaged very well and leveraged to improve maternal and child health,” he stressed.

A section of the TBAs including Madam Comfort Kwakye at Ata ne Ata and Madam Adjoa Pokua at Donkorkrom, in separate interviews confirmed the important lessons the training programme offered them and thanked organisers for presenting them with the TBA emergency delivery kits. Papa Dogo, ‘class prefect of the TBAs’ at Aportoyoawa near Goaso, reechoed the desire for the extension of the programme to cover more TBAs in the country. 

After the training for the 28 TBAs, Madam Princila Asor Frimpong, Public Health Midwife, in-charge of the Reproductive Child Health (RCH) Unit at the St. Elizabeth Catholic Hospital reports of the remarkable improvement in the numbers of referrals from the TBAs to the Hospitals and also commended their supportive role to pregnant women.

She acknowledged their dedication, commitment and sacrifices they were making to help improve on maternal and child health in their communities, noting the sacrifices  they make, to the extent of accompanying expectant mothers in labour to the hospitals as well as stay with them for the number of days they (pregnant women in labour) had to be at the hospital.

Administrator of the St. Elizabeth Catholic Hospital, Rev. Sr. Comfort Apedzi, also praising the general collaboration between the hospital and the TBAs, stressed the need for continuous education and sensitization among communities to help improve maternal and child health.

Other project areas

With success of the training programme at Hwidiem and its environs, the programme was extended to Mathias Catholic Hospital-Yeji and the Abease Catholic Health Centre both in the Pru District and under the Catholic Diocese of Techiman, where TBAs operating in remote areas including villages and islands on the Volta Lake were targeted.

Interacting with TBAs at Fawoman, Damankwanta, Abease, Abease-Krobo, Kamanpa and Cherambo communities, expressed how happy they were to have received the training, which a number of them recounted has helped them stopped the administration of local oxytocin (herbs and concoctions) to induce labour among pregnant women.

They said the 14-day training has taught them a lot on how to care for pregnant mothers and they now appreciate the essence of skilled deliveries. They appealed for mobile handsets to enable them communicate with the midwife at Abeasein matters of emergencies and referrals.

Noting the increased TBA referral of pregnant women to the facility, Madam Comfort Konadu, Midwife at the Abease Health Centre, commended the collaborative role of the TBAs, noting the efforts many of them were making including Madam Juliana Mansah, a neatly dressed TBA attached to the Clinic as well as Madam Comfort Donkor and Felicia Agyewaa at Damankwanta to maternal and child health.

Sharing her over three decades experience Madam Mansah also called for the training of more TBAs who were not covered in the first training programme, noting that the training has really improved their knowledge and skills of deliveries.

“It is worth understanding the TBAs’ beliefs and long traditional practice of conducting deliveries”, says Madam Dorcas Zenabu Seidu, Midwife at the Mathias Catholic Hospital-Yeji, and main facilitator for the training programme last April. She expressed the need for closer working relations between Midwives, health professionals and the TBAs since the latter has a lot to offer in heath delivery, especially in inaccessible areas.

She noted the increased referrals from trained TBAs some from Accra-town an Island of about 45minutes boat-ride from Yeji, and said it was a good thing to replicate the training programme to TBAs in other areas.

At Kayereso in the East Gonja District, under the Catholic Archdiocese of Tamale, Madam Agatha Atia, Midwife in-charge of the Clinic, noted the significant referral and the supportive role the TBAs were playing. The TBAs expressed delight at being trained last April and thanked the organisers for the efforts.

Six of the 35 TBAs trained at Baptist Medical Centre, Nalerigu in the East Mamprusi District in the Northern Region, indicated how helpful the 14-day programme has been to them. Some of them including Madam Arizata Muntari, an over 80-year old TBA at Nalerigu who resisted all efforts by the Centre to train her, until the April training even acknowledged how it had enlighten them on the harmful effect the local oxytocin they administered to pregnant women were and have since stopped.

Mr. Nelson Manduaya,in-charge of the Public Health Centre at the Baptist Medical Centre noted how the training has improved upon the trust and cordiality of the TBAs with the health facility. This he said has helped enhanced their efforts to refer more pregnant women to the hospitals.

Challenges

Even with its high prospect of scalability in the country, Mr. Yeboah noted that there were both internal and external challenges in sustaining the programme.

From the visit, most of the TBAs related challenges they faced with regards to getting ready means to transport to pregnant women to hospitals.

Some other challenges has to do with getting support and incentives to work with. The TBAs around Kayereso, Nalerigu, Abease and Yeji as well as Hwidiem noted that some incentives they used to receive after performing deliveries in the past had ceased, because members of the communities they worked in, thought government was paying them after the training programme.    

Conclusion

The Traditional Birth Attendants are no doubt a priceless human resources in the health delivery system, whose contributions are yet to be fully recognized, tapped and rewarded.

For now their services to deliver babies into the world and also enhance the health of the mother and child, remains primarily voluntary and indispensable to health delivery. But that they exist and work in inaccessible remote areas of our country where the aura of orthodox medicine is yet to reach, means they must be identified, engaged, trained and empowered to help perform better in healthcare delivery.

Using torchlights for deliveries

 ...Stories of Abease and Kayereso Health Centres

It was around 10:45pm in the evening, when one expectant woman in labour was rushed to the Abease Health Centre, which is by far the nearest health post from a distant village of about 20 kilometers.

The midwife upon seeing the stress the woman was going through especially after being transported on a motorbike on the virtually poor road network, examined her immediately and conducted the delivery with the aid of a torchlight.

Madam Comfort Konadu, Midwife in-charge at the health facility for the past nine years, narrates the ordeal they go through using torchlights and sometimes mobile phone lights to conduct deliveries at night and at odd hours, because lights are not in the community or at the health facility.

She recounts how challenging it was to use torchlights to conduct normal deliveries and sometimes managing deliveries which are usually referral cases from trained Traditional Birth Attendants in surrounding villages.

The Abease Health Centre, though the biggest health post in the area, is not the only one facing such challenges, as Kamanpa and Cherambo CHPS Compounds all in the Pru District of the Brong Ahafo Region faces similar challenges.

Another challenge Madam Konadu noted the facility was facing was delayed in payment by the National Insurance Authority for services the facility rendered, as well as the rising operational cost and maintenance of the only pickup for the Centre which does all the rounds, including transporting emergency cases to Yeji and other areas.

She said there was need for an ambulance, more critical staff including midwives at the facility and the expansion of the maternity ward, which is overcrowded, and appealed for adequate water supply to the health centre and the community, since the only borehole at the facility was overused because it was shared with members of the community.

Madam Konadu noted that due to increase in Antenatal Clinic attendance and deliveries at the health facility, associated with surge in  referrals and efforts of trained Traditional Birth Attendants (TBA) in surrounding communities, there was need for more midwives to help manage the work load. She said even with the effort her staff and that of Madam Juliana Mensah, a 57-year old TBA attached to the facility, there was need for more hands at the facility.

Asked how she preserves and stores vaccines and other drugs without electric power, she said they had arranged with Prang Health Centre about 30 kilometers from Abease, which has light to store them and later collect for use.

Meanwhile, the Kayereso Health Centre in the East Gonja District about 12kilometers from Salaga is also facing similar challenges of using torchlights to conduct deliveries.

Madam Agatha Atia, in-charge of the Kayereso facility with two staff noted the challenges they also go through to conduct deliveries at night with torchlights, and noted that even though the community was hooked unto the national grid mid this year, the facility was yet to be connected.

She said there were virtually no funds to run the facility since the NHIA was yet to reimburse the facility for services it rendered for the last six months, and added that because the facility had no water pregnant women had to carry their own water to the facility.

Madam Atia commended the invaluable cooperation and contribution of the 19 TBAs from surrounding communities, who were recently trained in March, for their roles to improve the health of expectant mothers and infants in the communities they operate in.

She noted the apparent difficulty they conduct they conduct outreach programmes to communities, especially without their own means of transport to communities in the sub district, and appealed to the Ghana Health Service, and other benevolent organization to come to their aid to purchase motorbikes to help them in their rounds.

To address the challenge expectant mothers in labour go through to get the health centre, Madam Atia together with the TBAs, opinion leaders mooted the idea to purchase a ‘motor king’ a tricycle motor to help transport pregnant women in labour to the health facility or nearest one in Salaga should there be complication to help save mother and infant.

So far, she reports that people in the various communities have contributed about GHc 500 towards the purchase of the motor king which is valued at about GHc 5,000. She appeals for support to help purchase the motor king to help the easy transportation of pregnant women in labour to health facilities.  

For people in these areas, access to quality healthcare will remain a luxury, even though it is supposed to be a right and a necessity for all Ghanaians. It will remain a luxury because of the cost involved in even transporting patients to the nearest health facility with bad road networks and other peculiar challenges associated to their areas.

*The Health Centres at Abease                 * A health Assistant attending to a client

*Madam Comfort Konadu (in white uniform) interacting with some staff

* (Above) Madam Agatha Atia interacting with

some of the TBAs the Clinic (below

By KwesiYirenkyiBoateng

  

Using torchlights for deliveries:

Stories of Abease and Kayereso Health Centres

It was around 10:45pm in the evening, when one expectant woman in labour was rushed to the Abease Health Centre, which is by far the nearest health post from a distant village of about 20 kilometers.

The midwife upon seeing the stress the woman was going through especially after being transported on a motorbike on the virtually poor road network, examined her immediately and conducted the delivery with the aid of a torchlight.

Madam Comfort Konadu, Midwife in-charge at the health facility for the past nine years, narrates the ordeal they go through using torchlights and sometimes mobile phone lights to conduct deliveries at night and at odd hours, because lights are not in the community or at the health facility.

She recounts how challenging it was to use torchlights to conduct normal deliveries and sometimes managing deliveries which are usually referral cases from trained Traditional Birth Attendants in surrounding villages.

The Abease Health Centre, though the biggest health post in the area, is not the only one facing such challenges, as Kamanpa and Cherambo CHPS Compounds all in the Pru District of the Brong Ahafo Region faces similar challenges.

Another challenge Madam Konadu noted the facility was facing was delayed in payment by the National Insurance Authority for services the facility rendered, as well as the rising operational cost and maintenance of the only pickup for the Centre which does all the rounds, including transporting emergency cases to Yeji and other areas.

She said there was need for an ambulance, more critical staff including midwives at the facility and the expansion of the maternity ward, which is overcrowded, and appealed for adequate water supply to the health centre and the community, since the only borehole at the facility was overused because it was shared with members of the community.

Madam Konadu noted that due to increase in Antenatal Clinic attendance and deliveries at the health facility, associated with surge in  referrals and efforts of trained Traditional Birth Attendants (TBA) in surrounding communities, there was need for more midwives to help manage the work load. She said even with the effort her staff and that of Madam Juliana Mensah, a 57-year old TBA attached to the facility, there was need for more hands at the facility.

Asked how she preserves and stores vaccines and other drugs without electric power, she said they had arranged with Prang Health Centre about 30 kilometers from Abease, which has light to store them and later collect for use.

Meanwhile, the Kayereso Health Centre in the East Gonja District about 12kilometers from Salaga is also facing similar challenges of using torchlights to conduct deliveries.

Madam Agatha Atia, in-charge of the Kayereso facility with two staff noted the challenges they also go through to conduct deliveries at night with torchlights, and noted that even though the community was hooked unto the national grid mid this year, the facility was yet to be connected.

She said there were virtually no funds to run the facility since the NHIA was yet to reimburse the facility for services it rendered for the last six months, and added that because the facility had no water pregnant women had to carry their own water to the facility.

Madam Atia commended the invaluable cooperation and contribution of the 19 TBAs from surrounding communities, who were recently trained in March, for their roles to improve the health of expectant mothers and infants in the communities they operate in.

She noted the apparent difficulty they conduct they conduct outreach programmes to communities, especially without their own means of transport to communities in the sub district, and appealed to the Ghana Health Service, and other benevolent organization to come to their aid to purchase motorbikes to help them in their rounds.

To address the challenge expectant mothers in labour go through to get the health centre, Madam Atia together with the TBAs, opinion leaders mooted the idea to purchase a ‘motor king’ a tricycle motor to help transport pregnant women in labour to the health facility or nearest one in Salaga should there be complication to help save mother and infant.

So far, she reports that people in the various communities have contributed about GHc 500 towards the purchase of the motor king which is valued at about GHc 5,000. She appeals for support to help purchase the motor king to help the easy transportation of pregnant women in labour to health facilities.  

For people in these areas, access to quality healthcare will remain a luxury, even though it is supposed to be a right and a necessity for all Ghanaians. It will remain a luxury because of the cost involved in even transporting patients to the nearest health facility with bad road networks and other peculiar challenges associated to their areas.

*The Health Centres at Abease                 * A health Assistant attending to a client

*Madam Comfort Konadu (in white uniform) interacting with some staff

* (Above) Madam Agatha Atia interacting with

some of the TBAs the Clinic (below

Male TBAs helping fight maternal mortality

At a time all hand are on deck to help reduce and minimize maternal and infant mortality rates in the country, Mr. Emmanuel Akatoh, an experienced Traditional Birth Attendant (TBA) in a predominantly female career, urges government andall stakeholder particularly males to support efforts to end maternal and child mortality in the country.

With over 150 deliveries to his credit over the past 44years as a TBA, Mr. Akatoh who is also known as Nana Dogo Moro, Chief of the Ewe settlers at Aportoyowoa, a village about 6km from the Goaso Cocoa Station, off the Hwidiem-Goaso Highway, says with collective efforts and support from all maternal mortality should be a thing of the past.

He recalls how he learned the act of delivering babies from his late grandmother as a young boy at Sogakope in the Volta Region but never practiced it until he relocated to Aportoyowoa in 1970, where he saw pregnant women struggling and suffering to give birth.

“I started to help in deliveries and was frequently called upon sometimes to help when the afterbirth delayed in coming,” he added.

Apart from her first child, Nana Dogo delivered his wife of all their six children as well as a number of his grandchildren with ease.

Although he has not performed deliveries that resulted in any complications or death over the years, he expresses worry about why women in the process of giving birth should lose their very lives.  

Papa Dogo, as he is affectionately called by the midwives at St. Elizabeth Hospital at Hwidiem in the Asutifi South District of the Brong Ahafo Region, narrated how he used herbs and other rehearsed traditional practices over the years to help in performing deliveries before receiving the training alongside other 27 TBAs in 2009, organised by the National Catholic Health Service in collaboration with the Catholic Diocese of Goaso and funded by Cordaid-The Netherlands.

He attested to the great enlightenment the 14-day training opportunity offered him and other TBAs, adding that it helped him to examine pregnant women, look out for possible danger signs and refer them to health facilities.

“The training for instance helped me in visiting and sensitizing pregnant women on the need to attend antenatal clinic as well as encourage lactating mothers to attend postnatal care,” he added.

Papa Dogo shared the experience of being woken at odd hours of the night to go for deliveries at very distant cottages, sometimes walking for hours and having to cross rivers before getting to where the pregnant women in labour were.

In his haste to go and perform one of the emergency deliveries in one of the hamlets recently, he described how he slipped and fell from a rickety-wooden access bridge to the hamlet. Though he sustained some injuries and bruises, he rose and went to the village to help deliver the pregnant woman of her baby.

Asked why he had to go after sustaining the injuries, he said the life of the woman in labour and the child were of concern to him, adding that was why he had to still go in spite of the pain he was going through after falling from the bridge.

Indeed, the TBAs work, as voluntary as it is, is not an easy task at all, as very often their time, efforts, sacrifices and risk to respond to the calls at odd hours is not compensated.

Answering how challenging the work is, Papa Dogo confirms that “the work is not easy at all”, noting that they are yet to receive any form of motivation for the work they were doing.

Madam Princila Asor Frimpong, Public Health Midwife, in-charge of the Reproductive Child Health (RCH) Unit at the St. Elizabeth Hospital described as impeccable the roles Papa Dogo and other TBAs who received training from surrounding towns and villages were contributing with regards to skilled deliveries.

She together with some midwives at the RCH Unit confirmed increased referrals of pregnant women to the Hospitals by the TBAs, who also accompany the pregnant women in labour to the hospital. The midwives also acknowledged the TBAs efforts in educating the pregnant women about the need to attend antenatal clinics, which according to reports has soared.

“Papa Dogo and the other TBAs are doing well as they have taken more active interest in the welfare of the expectant mothers and their infants, with their (TBAs) regular visitations, sensitization on appropriate diet and care expectant mothers and lactating mothers ought to take” Madam Frimpong added.

Touching on the eye opening experience the 14-day training offered him in areas of infection prevention during emergency deliveries, Papa Dogo suggested the replication of the training throughout the country to educate, sensitize and make TBAs help in enhancing skilled and safe deliveries in the country.

He called on the government and stakeholders to consider ways of supporting the TBAs to collaborate more effectively with health facilities to ensure more safe deliveries and reduce maternal mortality.

In a similar development, 80-year old Nayina Komoa, another male TBA at Kulgona a village of about 13 kilometers from Nalerigu in the East Mamprusi District of the Northern Region also recounted his experience as a TBA for the past 50years, and having delivered hundreds of babies, including 17 of his 20 children.

Hitherto the recent training he received together with 35 TBAs in the catchment area of the Baptist Medical Centre at Nalerigu in March 2014, he faced challenges in performing deliveries, with breech birth presentations and other complications.

Speaking through an interpreter, Nayina stated how beneficial the training has been to him and even demonstrated how to perform emergency deliveries, and also ensure infection prevention as well as refer pregnant women to the hospital.

Mr. Nelson Manduaya, in-charge of the Public Health Unit of the Baptist Medical Centre commended Nayina and other TBAs were doing and even confirmed an increase in referral from Nayina to the Hospital.

Like Papa Dogo, Nayina who is also a Traditional Medical Practitioner (TMP) said he learned the act of performing deliveries from his late grandfather and his mother who were conducting deliveries then.

Describing the 14-day training programme for the TBAs as an eye opener, Nayina commended the organizers seeing the need to educate them for them to collaborate to enhance skilled deliveries, and called for the training to be expanded and replicated to train more TBAs.

Nayina who is also a farmer said as part his work as a TBA he organizes regular meetings among TBAs from 13 surrounding communities to share ideas on their work at their level and discuss pertinent issues relating to their work.

He also expressed the concern that the women who were delivered do not pay anything, and urged the husbands to support the TBAs for the efforts they make.

There is no doubt age is telling on Papa Dogo and Nayina who are appealing for the training of more TBAs to support and gradually take over from them, when they are no longer there.

How bracelets increased ANC attendance at Hwidiem

It looks fashionable and elegant on the hands of pregnant women. And a first timer is likely to mistake them for Ghana Black Star fans. However, it is more or less a certification or an insignia to show that the pregnant women wearing it were taking their Sulpadixine Pyramethanine (SP) drugs.

The SP drug is an Intermittent Preventive Treatment of Malaria for Pregnant Women (IPTp). Health experts say Malaria infection during pregnancy can have adverse effects on both mother and foetus, including maternal anaemia, foetal loss, premature delivery, intrauterine growth retardation, and delivery of low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death.   

Madam Princila Asor Frimpong, Public Health Midwife, in-charge of the Reproductive Child Health (RCH) Unit at the St. Elizabeth Catholic Hospital at Hwidiem, has been explaining that the introduction of the SP drug with bangles, was to encourage pregnant women attend regular antenatal clinic and take the tablets in order to prevent malaria.

Research findings are that Malaria was the leading cause of death among pregnant women in Ghana, a situation which prompted the Ghana Government to introduce the SP drugs to prevent malaria and reduce maternal mortality.

However, after the introduction of the drugs which was free, accessible and affordable, Mr. Peter Yeboah, Director of Health Services in the Catholic Diocese of Goaso, observed a significant decrease in the demand for maternal health services amongst pregnant women, against the backdrop of high maternal mortality rate in the Hwidem and its catchment area.

Thus, after a baseline study, he explains that his outfit and St. Elizabeth

Hospital with support from their partners, introduced the SP with the bracelets project, as a means of incentivizing pregnant women to attend antenatal clinic and take the SP drug. This simple approach he noted caught on well among pregnant women and their communities.

Similarly, Madam Frimpong states that as a result of the continuous education and sensitisation through outreach programmes as well as other ongoing related programmes, more pregnant women within the Asutifi South District and beyond now patronize antenatal clinic.

As a result of effective supervision in administering the SP drug to the pregnant women over a five-year period, Mr. George Osei-Owusu, Statistician at the Hospital, reported a 58.35 per cent reduction in malaria among pregnant women and recorded a 56.53 percentage increase in Child birth deliveries at the facility.     

He noted that between 2008 and 2013, the hospital registered 11,356(in 2008) and 22,206 (in 2013), representing 95.54 per cent of Antenatal Clinic (ANC) attendance in the five-year period.

Available data on ANC attendance at the hospital beyond 2009 increased to by 4,169 from the previous years’ 11,356 and increased to 18,813; recording the highest of 23,720 in 2012. The hospital also recorded 38.36 per cent drop in Maternal Mortality Rate and 48.19 per cent reduction in Still Birth Rates over the same period.

The Statistician also intimated that the intervention of SP with bangles project for pregnant women and the collaborative efforts of Traditional Birth Attendants(TBAs)in the area, as well as other interventions including the Project Five Alives!, Insurance for pregnant women and the sensitization embarked upon by the Hospital’s outreach team in surrounding communities has contributed to improved maternal and child health, and the significant reduction in maternal and infant mortality rates at the hospital.

Some pregnant women at the RCH recounted how the bangles served as a reminder of their next antenatal visit, as well as encourages other pregnant women in homes to visit the health facility. They even expressed reason why they loved wearing the bracelets, stating that it symbolizes they were healthy and would give birth to healthy babies.

A pregnant woman, Madam Gladys Akom, a mother of four who resides at Nkrankrom, about six kilometers (6km) from Hwidiem, says her curious peers asks her about why she wears the bangles. She in turn, explains to them about the importance of the SP drug, which prevents malaria among pregnant women and ensure their strength and that of the foetus.

“Every pregnant woman should try and take the drug to keep them and their babies healthy”, she advised, and affirmed that the drug makes her and the foetus feel stronger.

With a shyly smile, Madam Kotime Alhassan, another pregnant woman from Nkaseim, a hairdresser and a mother of one, who has not taken the drug during her first pregnancy, related the difference she feels.

Like Madam Gladys, Madam Kotime also said a pregnant woman who inquired from her what the bracelets was all about, later followed up at the hospital to attend antenatal and take the drug.

There is no doubt that the introduction of the bangles has increased the number of pregnant women visiting the antenatal and taking the SP drug, as a lot of them from other Districts such as Asunafo North and South and even some from as far as the Western Region travelled to access healthcare at the facility.

Elaborating further, Madam Theresah Ankamaa and Madam Grace Obiyaa, Staff Midwives at the RCH Unit stated that before administering the drug pregnant women in their second trimester of the pregnancy or during 16 to 20 weeks of gestation, were examined before being administered with the drug, adding usually women who show indications of full or partial defects of drugs containing Sulphur are taken out of the programme and offered alternative malaria preventive drug.

There is this aura of belief among the pregnant women and people in their communities that any expectant mother without the bangles was unsafe, thus it becomes obligatory for pregnant women in such communities to attend antenatal clinic and get her share of the ‘healthy bangles’.

Challenges

The programme which has increased the ANC attendance and pressurizing the few staff at the RCH Unit who had to work for long hours.

There has been an over-subscription of the SP drug at the Hospital and limited as well as delayed supplied of the drugs, which puts additional drain on the hospitals’ internally generated funds which is used to purchase the SP drug to administer to the pregnant women for free.

Another challenge has to do with sustaining the programme of free administration of SP drug to pregnant women for the future vis-a-vis the need for improved quality healthcare delivery to the people in rural areas. 

Conclusion

The success story of how bracelets contributed to increasing ANC attendance, shows that with commitment, local innovative schemes and consistency in education we can significantly reduce maternal deaths, improving maternal and infant health, and ultimately inch closer to meeting the health related Millennium Development Goals in the country.