The impact of community sensitization and dialogue on maternal health in Agona East District

 

Given the fact that maternal death and it related problems pose serious challenges to Ghana and other countries especially in Sub-Sahara Africa, it has become necessary for the implementation of policies to remedy the problem before it get out of hand. In our quest to stop this growing phenomenon that is killing our dear women and children, Millennium Development Goal 5 was put in place to serve as a roadmap directing countries bedeviled with these challenges to take bold steps to bring it to a halt.In Ghana, various intervention programmes by the government and Civil Society Organizations (CSOs) have been implemented to reduce maternal death and it impacts on our economy in order to reach our target of 185 per 100,000 live births by 2015. Having this bench mark, interventions such as Safe Motherhood Initiative, Millennium Development Accelerated Framework, National Health Insurance Scheme, and Free Delivery Services among others have been rolled out to tackle the problem.
In Agona East District of the Central Region, the story was more serious as women continue to die as they give lives. One thing that cannot be overlooked is the fact that most of the communities in the District are deprived and seem to be detached from the District Capital, Agona Nsaba. In effect, women in labour would have to be conveyed over a long distance before they can have access to healthcare. The road leading to these villages are not motorable and in some of the communities hardly do vehicles commute there.
These challenges in the District urged SEND Ghana and Young and Lonely Foundation (YLF) to explore various complex interventions to help remedy this complex problem of maternal mortality. As part of the interventions, they advocate for women and children, promote education and sensitization in the communities, form District Citizens Monitoring Committees (DCMC), and hold stakeholders accountable for their stewardship. Their objective and influence has yielded some results. Maternal death keep reducing, women are now seeking medical care as barriers in the health facilities are partially eradicated.
Another curative intervention arrayed by the Young and Lonely Foundation (YLF) in their quest to combat maternal mortality is branding of occasions as maternal health occasion. YLF realized, after their study on the peoples’ response to health issues, that most people in the communities listen to their religious leaders, traditional authorities and some philanthropist in the communities better than the health workers so decided to integrate maternal health education and sensitization into all the occasions organized in the communities. With this, they created the platform for these influential people in the community to educate the communities on the need to take maternal health serious.
To champion this cause, the Young and Lonely Foundation came into a consensus with the traditional authorities of the Agona Nsaba, the District Assembly, the health service directorate and some philanthropists to give maternal health a major boost during the Akwambo festival, thus branding the festival as a maternal health festival.During the festival, Young and Lonely Foundation and the DCMC members were given the platform to educate the people on maternal health. The team led by Gilbert Germain (Director, YLF) thanked the chiefs and other stakeholders in the district for creating a forum during the festival so that the people can learn more about maternal health. He then highlighted the purpose of the MDG 5, and why all hands must be on deck to tackle maternal mortality in the communities. He schooled the gathering on antenatal care, supervised delivery at health institutions, postnatal care and why they should be observed. He urged the traditional authorities, health service directorate, district assembly, GPRTU, TBAs, NHIA, communities and the pregnant women to play their roles well so as to meet the maternal health goal sooner than later.
The chief and some opinion leaders who had their turn to speak also appealed to the district assembly and the health directorate to fast truck the establishment of a district hospital to serve the health needs of the district. At the end of the festival, the traditional authorities agreed to use the funds raised and monies realized to support the construction of a laboratory at the Nsaba Health center. Since the implementation of complex interventions by the Young and Lonely Foundation in the Agona East District, maternal health has now seen a face lift as pregnant women now seek timely antenatal, postnatal and neonatal care and also have develop positive attitude to seeking proper health attention at the health centers in the communities. Again as part of the success stories, the Young and Lonely Foundation through periodic dialogue with the District Assembly and Health Service Directorate on accountability and improved health service delivery has helped in taming maternal mortality as health personnel continue to do their best to enhance service delivery as well as improve their human relations which has bedeviled the district since pregnant women choose to stay in the house than to suffer the hot ferocities of the impatient nurses at the health centers.
Furthermore, through the efforts of YLF, CHIPs Zones are opened and made operational in some of the communities and more health workers have been transferred to the district, which have removed the barriers faced by people in the communities in accessing proper medical care.
The path to reaching our target of 185 per 100,000 live births by 2015 is very coarse, even though some helpful interventions have been interjected to halt the problem of maternal mortality, it is not enough since some barriers are still fretting maternal health in Ghana. The Young and Lonely Foundation will still champion the fight against maternal mortality and push forward their agenda of zero tolerance to maternal mortality.
It is the little drops of water that makes a mighty ocean, so we believe that if all the stakeholders and organizations in the country are to put in a little effort to help curb this canker of maternal mortality, then our success story would not be infinitesimal but would be the full attainment of our target of 185 per 100,000 live births and gradually record zero in not too distant future.
Written by: Philip Doe Amaglo, Young And Lonely Foundation, Agona East.

INTRODUCTION
Given the fact that maternal death and it related problems pose serious challenges to Ghana and other countries especially in Sub-Sahara Africa, it has become necessary for the implementation of policies to remedy the problem before it get out of hand. In our quest to stop this growing phenomenon that is killing our dear women and children, Millennium Development Goal 5 was put in place to serve as a roadmap directing countries bedeviled with these challenges to take bold steps to bring it to a halt. In Ghana, various intervention programmes by the government and Civil Society Organizations (CSOs) were implemented to reduce maternal death and it impacts on our economy. Our goal is simple; that by 2015 we shall reach a target of 185 per 100,000 live births. Having this bench mark, interventions such as Safe Motherhood Initiative, Millennium Development Accelerated Framework, National Health Insurance Scheme, Free Delivery Services among others were rolled out to tackle the problem.
In Agona East District of the Central Region, the story was more serious as women continue to die as they give lives. One thing that cannot be overlooked is the fact that most of the communities in the District are deprived and seem to be detached from the District Capital, Agona Nsaba. In effect, women in labour would have to be conveyed over a long distance before they can have access to healthcare. The road leading to these villages are not motorable and in some of the communities hardly do vehicles come by.These challenges in the District urged SEND Ghana and Young and Lonely Foundation (YLF) to do something about the situation. Their objective in this regard is to continue to advocate for women and children, education and sensitization in the communities, formation of District Citizens Monitoring Committee (DCMC),and holding stakeholders accountable for their stewardship. Their objective and influence has yielded some results. Maternal death keep reducing, women are now seeking medical care as barriers in the health facilities are partially eradicated.In the final quarter of the maternal health project in the Agona East District, the organizations focused on collecting feedback from DCMC, progress made so far, organizing a health festival durbar to climax the project, challenges and the way forward.
MEETING THE CHIEF AND ELDERS OF AGONA NSABA
On Saturday, 25th October, 2014 the YLF team lead by the director Gilbert Kofi Germain visited the Chief’s Palace at Agona Nsaba to pay homage to the chief and elders of the community for fulfilling their promise of making their annual festival a maternal health festival this time around. The team also discussed some pertinent issues concerning how maternal death can be wiped out completely from the District. During the meeting, he congratulated the chief and elders of Nsaba for speeding up efforts to fight maternal death in the District. The director also informed the chief and elders that the organization has invited various stakeholders in the District so that they dialogue and ascertain the progress they have made so far concerning their commitment to do something about the maternal death situation.
The chief in response applauded the Young and Lonely Foundation (YLF) for their intervention. According to him, the series of maternal health education and liaising with stakeholders is indeed going a long way to reducing their predicament. He admonished the organization not rest on their ores but should continue to champion maternal health in the District and sooner than later, the District will record zero for maternal death. The chief made one appeal, in his appeal he argued that the maternal health problems in the district are as a result of lack of education on the part of their female children. “There is no one to support the girls to further their education” he said. He continued that every year, the girls perform very well during their BECE but do not get the support to continue their education. According to him if YLF can collaborate with stakeholders and other Civil Society Organizations to give scholarship to these young girls, they will spend more time in school and will concentrate on their careers by so doing maternal death will not be an issue worth discussing, because it will be non-existent. The director of YLF agreed with the chief on his permanent solution and promised to speak with stakeholders, philanthropist etc. to support female education in the District.

MONITORING AND MEETING THE DCMC MEMBERS OF THE DISTRICT
On 3rd June, 2014, the District Citizens Monitoring Committee (DCMC) members coupled with other stakeholders in the District were trained to advocate maternal health in the District. As part of their job description, they were assigned to duty bearers and are required to report to YLF on issues relating to maternal health. The works of the committee are constantly monitored by the focal organization. The committee as part of their duties submits reports on maternal health to the focal organization. Below are the feedbacks received from some members of the committee.

Nana Ekua Appiah, Queen Mother, Agona Nsaba
Our main goal is to make the Nsaba Health Centre a Hospital, so we are collaborating with all stakeholders in the District and beyond to make sure that our goal comes to pass. Our medium term goal is to establish a laboratory at the health centre so that clients can have access to laboratory services right in Nsaba.
On the issues of access and patronage of health services by pregnant women, she said the education and series of interventions in Nsaba and its environs are going a long way to making people seek health services this time around. They have also removed some of the barriers within their domain at the health centre and the results from clients are now okay. One of the barriers, she said was removed, was the bad attitude of health workers especially midwives. She revealed that midwives that clients were not comfortable with because of their poor service delivery were transferred and new ones who were ready to serve the people were brought on board.
Furthermore, she said CHIPs Zones are opened and made operational in some of the communities and to her is a step in the right direction. She also suggested that we should do something about the road network during our next intervention because it also accounts for maternal death especially in the rural communities.
On what should be done to improve upon the standard we have set now, she recommended that education and sensitization should continue unabated so that the message can go down well. In addition to this she encouraged the focal organization to bring on board spiritualist in the communities so that together we can come to a consensus as to how to nip the problem in the bud. To her, women listen to these spiritualists more than the health workers and it is a barrier that must be removed in our voyage to meeting MDG 5.

Madam Eunice, Agona Duakwa
Maternal health advocacy in the communities is reducing maternal health problems. Delivery especially at the Duakwa Salvation Army Health Centre is now okay as women seek antenatal care services immediately they are pregnant. The problem she has experienced with delivery at the health centre is that midwives demand unapproved monies from clients. “Give me something from your heart” she said the midwives would ask and they mean it. It is a phenomenon that she and authorities are doing their best to stop.
On the way forward,she cautioned young girls to stick to their books and should not live promiscuous lives because it will turn their fortunes upside down. According to her, parents must play their part in providing the needs of their female children.This would prevent them from falling on men for money which may lead to the unexpected. Also, they should be friends to their children especially female children. This will make their female children reveal confidential pieces of information to them so that the appropriate remedies can be applied.

Madam Dora, Agona Nsaba
From the reports she gathered, clients are very assertive about their rights as far as health is concern. She asserts that clients are accessing healthcare at the Nsaba health Centre because some of the frustrations clients go through when they visit the health facility are now removed. She said intermittent dialogue with the District assembly, health service directorate on accountability and improved health service delivery has helped in taming maternal mortality as health personnel continue to do their best to enhance service delivery.
She reported that initially, pregnant women did not carry delivery items along with them during labour. That is they wait till the eleventh hour before rushing to acquire some few items. According to her, education in the communities on maternal health and formation of health committees have increased attitudes towards antenatal care services hence pregnant women are able to prepare adequately before delivery. Finally, she said the health workers have improved their human relation towards clients. She advised that we should continue with the education in the communities in order to forestall any relapse.

Madam Theresa Yeboah, Agona Kwanyako
She has become a strong advocate for maternal health especially among the women in her community, Kwanyako. What she does is to visit pregnant women andto take them through some education on how to take good care of themselves and visiting health facilities on regular bases.
Young boys and girls are not left out of her education as she meets them to educate them on the need to stick to their books than havingboy or girl friends at their age. She narrated an interesting experience relating to one or two of her engagements with some of the adolescents in her community. According to her, she eavesdroppedon a conversation between three young adolescent girls who discussed the amount of money their boyfriends give them every day. She could not withstand what the girls were discussing and had to pop in to counsel them. During their interaction it was realized that the parents of the girls have not been giving them money for school and in their bid to feel comfortable at school, they have to fall on the boys who happen to be school dropouts and who are now selling coconut on the street.
She visited the parents of the girls to hear their side of the story. After the interaction, it was realized that, the parents have shown a lukewarm attitude towards the maintenance of the girls in school. She counseled the parents on the significance of taking care of the needs their children either than that theirchildren would be lead astray by friends. Madam Theresa Yeboah did not end there but went further to the boys in question to counsel them so that they can turn on a new leave. She has also been speaking with adolescent boys in the town since they impregnate the teenage girls. She always educated them to desist from all forms of deviant and promiscuous lives as it will be detrimental to their future. On how the Kwanyako Health Centre is doing in terms of service delivery especially in the area of antenatal care, supervised delivery and postnatal care, she explainedthat, the services are good but in case of any complications, clients are transferred to the Swedru Municipal Hospital for treatment. She further explained that the attitude of the people of Kwanyako toward seeking proper medical attention at the health centre has improved. The problem she said has to do with those in the surrounding villages, as they still exhibit poor attitude toward accessing the health centre for their health needs.
Finally, she appealed to the organization to liaise with the District Health Directorate to organize a training programme for the Nurses on quality customer care. She also pleaded that Clients must be counseled so that they would go by the prescriptions given to them at the health centre.
Bright Amissah He is much concerned about teenage pregnancy and the effects of maternal mortality on families and the community alike. He revealed that Agona East District happens to be the second leading district plagued with teenage pregnancy in the Central Region of the country. According to him, this is a serious challenge to their efforts in the communities because the teenage mothers are stigmatized by the community due to their condition at that early age and so do not visit the health centre to seek for proper antenatal care. Also, most of the communities in the District where this incidence is recorded are very deprived and cars hardly commute there. In situations where cars are available, the women cannot afford. He asserts that it will be very necessary for us to include free transport in the NHIS for pregnant women living in very remote areas of the country. He added that we can’t meet our goal of 185/100,000 live births if these barriers in the deprived communities are not removed.
On the role of the DCMC members, he said they are making serious impact on their communities and the maternal health message is going down well. Service delivery at the health centres are improving and women are now prioritizing the need to visit health facility immediately they are pregnant and when they are in labour. He appealed to the district health directorate, district assembly and other stakeholders to step up efforts to put up a District Hospital so that the health needs of the people in the District could be fully met. He also thanked the traditional authorities for their role in promoting health and also for branding their annual festival a maternal health festival this time around.

Osbert Aniaku, Ghana Health Service, Agona Nsaba
One of our major objectives is to ensure the availability of health personnel at CHIPS Zones so that they can always give health services to the clients. At the moment, we have a CHIPS coordinator who is in charge of monitoring health personnel who operates in the CHIPS Zones. The coordinator is required to write quarterly reports which are forwarded to the district director of health. Items that are featured in the report among other things are number of health talks held, outreach programmes conducted, number of pregnant women seen and number of children seen.
According to him, as part of the success story, the district health service is now collaborating with PLAN-GHANA to carry out vaccination programmes for pregnant women in the communities. Another success chalked during the period is that; a durbar has been organized in two CHIPS Zones namely, Kenyanko and Ofuasi. During the durbar, they dialogued with the communities members and they encouraged them to make inputs on health matters so as to improve service delivery.Again, through their effort, the Nsaba health centre which had only one midwife can now boost of three midwives. Furthermore, there was monitoring on safe motherhood, this was done to prevent

DURBAR TO CLIMAX THE PROJECT
The maternal health project in the communities was climaxed during the Akwambo festival. Earlier on, Young and Lonely Foundation came into a consensus with the traditional authorities, the District Assembly and the health service directorate to give maternal health a major boost during the festival.During the festival, Young and Lonely Foundation and the DCMC members were given the platform to educate the people on maternal health. The team led by Gilbert Kofi Germain (Director, YLF) thanked the chiefs and other stakeholders in the district for creating a forum during the festival so that the people can learn more about maternal health. He then highlighted the purpose of the MDG 5, and why all hands must be on deck to tackle maternal mortality in the communities. He schooled the gathering on antenatal care, supervised delivery at health institutions, postnatal care and why they should be observed. He urged the traditional authorities, health service directorate, district assembly, GPRTU, TBAs, NHIS, communities and the pregnant women to play their roles well so as to meet the maternal health goal sooner than later.
Bright Amissah, a DCMC member who doubles as the Central Regional Chairman of the Coalition of NGOs in health was also given the opportunity to do a presentation during the occasion. According to him, maternal mortality is a pressing issue and has been eating us up for far too long. He continued that teenage pregnancy cases in the District are another source of worry as they thwart the efforts of the District towards meeting maternal health goals. He underscored the need to put up a District Hospital so that clients can have improved health care services in the District. To bring his speech to a close, he raised an agenda for zero tolerance for maternal mortality. He asked “who would like the wife, mother, sister, friend to die during labor? “The answer is no” he said. He urged all those who have a say in health to fast truck the establishment of a District Hospital because it is one of the surest ways of solving our health problems and maternal mortality is no exception.
During the turn of the Chief of Agona Nsaba, he lauded the efforts of all the stakeholders in the District for playing their roles in diverse ways in reducing maternal health problems. On health, he appealed to the stakeholders especially the assembly to put up a Hospital for the District. He announced that money realized during the festival would be used to support the construction of a laboratory at the Nsaba Health Centre.

DIALOGUE WITH STAKEHOLDERS IN THE DISTRICT
In rapping up with the maternal health project in the communities, YLF team had a final meeting with the District assembly and the Health service directorates. The purpose of the meeting was to find out from them the impact of the projects and what needed to be done in order to improve the health situation of the people in the District.

THE DISTRICT ASSEMBLY
The Agona East District Planning Officer who spoke with the YLF team revealed that the maternal health Project by Send GH and YLF has been beneficial to the people and the District assembly. According to her, the project has helped people to access the health facilities. ‘They provide the facilities but without the education in the communities by NGOs, the maternal health problems will still continue’ she used the medium to laud the efforts of SEND Ghana and YLF, that they help them to know the realities on the ground which helps them to do effective planning to alleviate the problems that the communities go through.
The planning officer made the following recommendations. These can be seen below:

• The NGOs should support in upgrading the Nsaba health centre into a District Hospital
• Assist in the provision equipments in the health centres
• They should continue to deepen sensitization in the communities especially on health

DISTRICT HEALTH DIRECTORATE
A discussion with the team revealed that the interventions, advocacy and education in the communities especially on maternal health by the NGOs (SEND GH and YLF) have brought a lot of positive changes in the health facilities and health delivery. Some of the positive changes they mentioned include the following;

• Adequate personnel to handle the CHPS compounds and CHPS Zones
• A temporary laboratory section has been created at the Nsaba Health Centre
• A staff has been employed for laboratory services at the Nsaba Health Centre
• A permanent laboratory is under construction
• Domiciliary delivery: that is midwives moving to the communities with delivery kits to delivery issues in the homes of clients.
• Increase in the number of midwives to aid delivery
• Five sub-districts health facilities have been created and they are operating day and night to support delivery.
• More clients are now patronizing health services especially pregnant women and nursing mothers.
• The health directorate made the following recommendations:
• The NGOs (YLF, Send GH) should submit reports on their interventions and results regularly to the health directorate so that they can serve as reference documents and a guide so that they can factor the findings into their plans
• Education and sensitization should be intensified in the communities in order to eradicate health problems especially maternal mortality in the communities.

SUCCESSES CHALKED
As a result of the interventions put in place by Young and Lonely foundation, SEND-Ghana and other stakeholders to help combat maternal mortality in the Agona East District, the following are the successes chalked so far:

• the health seeking behaviors of pregnant women have improved according to the DCMC members and duty bearers
• A laboratory at the Nsaba health center is under construction
• Platforms are created during various occasions to promote maternal health education and sensitization in the district
• Through constant dialogue with the district assembly, they are now ready to put up a district hospital
• There has been an increase in the number of midwives at the health centers to promote supervised delivery
• The traditional authorities have also been successfully brought on board to take part in the maternal health project.
• More CHIP Zones have been opened and made operational during the project implementation period
• NHIA office to be opened in Agona East District next year according to the planning officer

THE WAY FORWARD
Due to the complex nature of maternal health problems, there is the need for all and sundry to join in the fight to help eradicate maternal mortality from our communities. There is also the need to do more education and sensitization in the communities so that people will understand the need to take maternal health serious as well as the provision of the necessary amenities and support needed in the deprived areas where maternal mortality is rampant so that the situation can be curbed.

CONCLUSION
Even though there have been lots of challenges to the implementation of the maternal health projects in the Agona East District, Young and Lonely foundation, SEND-Ghana and other stakeholders in the district have made an impact in the lives of the community members. Today, access to health care has increased, pregnant women are now seeking the services of professionally trained midwives and traditional authorities are poised to fight maternal mortality in the district. Some targets have been achieved but more need to be done if we want to eradicate the problem completely.

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