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. 2012 Nov 16:12:991.
doi: 10.1186/1471-2458-12-991.

Geographical access to care at birth in Ghana: a barrier to safe motherhood

Peter W Gething  1 , Fiifi Amoako Johnson, Faustina Frempong-Ainguah, Philomena Nyarko, Angela Baschieri, Patrick Aboagye, Jane Falkingham, Zoe Matthews, Peter M Atkinson
Affiliations

Geographical access to care at birth in Ghana: a barrier to safe motherhood

Peter W Gething et al. BMC Public Health. .

Abstract

Background: Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa.

Methods: We assembled detailed spatial data on the population, health facilities, and landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care.

Results: We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the 'partial' standard or better. Nearly half (45%) live that distance or further from 'comprehensive' EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios.

Conclusions: Detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve.

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Figures

Figure 1
Figure 1
Schematic diagram showing main input data, analytical steps, and primary outputs in generation of a calibrated nationwide journey-time model. SAE = small area estimation; EA = enumeration area; WoCBA = women of childbearing age.
Figure 2
Figure 2
Modelled journey-time to health facilities offering care at birth. Mapped values show estimated journey-time via (top row) mechanised and (bottom row) non-mechanised transport from each pixel to the nearest facility offering (A and D) any level of care at birth; (B and E) Partial/Basic/Comprehensive EmONC services; or (C and F) Comprehensive EmONC services. Facilities of each type are overlaid as black dots and district and regional boundaries are also shown.
Figure 3
Figure 3
District level summaries of estimated geographical access by women of childbearing age to nearest health facilities offering care at birth. Panels relate to facilities offering (A) any level of care at birth; (B) Partial/Basic/Comprehensive EmONC services; and (C) Comprehensive EmONC services. District and regional boundaries are also shown.
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