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Hospital based maternity care in Ghana : findings of a confidential enquiry into maternal deaths

By Janet Ansong-Tornui, Margaret Armar-Klemesu, Daniel Arhinful, Suzanne Penfold and Julia Hussein


Background: In Ghana, a universal free delivery policy was implemented to improve access to delivery care in health facilities, thereby improving access to skilled attendance and reducing maternal mortality. Objective: A confidential enquiry was conducted to ascertain if changes had occurred in the care provided by reviewing the care given to a sample of maternal deaths before and after introduction of the policy. Method: Twenty women who died as a result of pregnancy-related complications (maternal deaths) in selected hospitals in two regions were assessed by a clinical panel, guided by a maternal death assessment form. Unlike the traditional confidential enquiry process, both adverse and favourable factors were identified. Findings: Clinical care provided before and after the introduction of the fee exemption policy did not change, though women with complications were arriving in hospital earlier after the introduction of the policy. On admission, however, they received very poor care and this, the clinical panel deduced could have resulted in many avoidable deaths; as was the case before the implementation of the policy. Consumables, basic equipment and midwifery staff for providing comprehensive emergency obstetric care were however found to be usually available. Conclusion: Our findings suggest that the already poor delivery care services women received remained unchanged after introduction of the policy.This work was undertaken as part of an international research programme - Immpact (Initiative for Maternal Mortality Programme Assessment). See:, funded by the Bill & Melinda Gates Foundation, the Department for International Development (DFID), the European Commission and the Unites States Agency for International Development (USAID)

Topics: Hospital, Maternity care, Confidential enquiry, Maternal deaths
Publisher: Ghana Medical Association
Year: 2007
OAI identifier:

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