A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis

Abstract

The achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of 'free' delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the 'free' delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.

Fig 1. PRISMA-SCR Flow diagram of literature selection.

Grey and peer reviewed articles date between 2005 and 2022.

Fig 2. A conceptual Framework of factors influencing SBA in Ghana.

The framework shows the interactions of these factors and how they influence SBA in the Ghanaian context.

Fig 3. Fishbone analysis of the residual barriers to achieving SBA target in Ghana.

The inscriptions in bold, have been identified as the major factors influencing the utilization of SBA in Ghana. Poor health financing and management, inefficient health governance, inefficient supply and organization of medical products/infrastructure, couple with insufficient and inefficient health workforce, results in the overall inefficient health service delivery, such as poor organization/coordination of services and poor quality of health service delivery. Other community factors such as geographical, sociocultural, and economic barriers to SBA, and poor maternal health seeking behavior also impact on SBA in Ghana.