Safe Motherhood Programme

1. Safe Motherhood Programme Public Health Annual Performance Review 2006

2. Goal • The goal of the Safe Motherhood Programme is to improve women’s health in general and especially, to reduce maternal morbidity and mortality and to contribute to reducing infant morbidity and mortality

4. Trends in ANC coverage

5. Teenage pregnancy

6. Ashanti and GAR under performed. Coverages were below 80%. • Shortage of maternal health records cards in the second half of the year affected coverage.

7. Utilization of ANC services • Early Initiation of services • Number of visits • Adequacy of service package

9. ANC – 4+ visits. • ANC provides us the best opportunity in accessing women and provide care • Making adequate number of visits is key to improving pregnancy outcomes

11. TT Coverage

12. ANC - cont Risk Detection • Parity 5+ • National – 9.9% • 7 regions measured parity 5+ • BA, CR and UW did not measure parity 5+

13. Anaemia in Pregnancy

14. Total delivery Trends

17. LOW BIRTH WEIGHT AND STILL BIRTH RATE • 11387 still births (2006) compared to 11063 (2005) • 6 regions reported higher proportions of MSB • MSB 50.4% FSB 49.6%

18. Neonatal deaths • There 4,669 new born deaths representing 88% of the total infant deaths (5291)

19. INSTITUTIONAL MATERNAL MORTALITY RATIO • Though MMR decreased • Total deaths increased from 912 in 2005 to 957 in 2006 • 148 (15.5%) were adolescents

21. Maternal Death Notification • Started in January 2006 • 471 deaths notified out of 957 maternal Deaths • GAR(24%), ASH(19%) and VR(16%) with the least proportion reported.

22. Maternal Death Notification

23. Maternal Death Notification

28. Essential Obstetric Care (EOC) • There has been gradual improvement and availability of EOC C/S Rate • National – 6.9% • Increased from 6.1% in 2005 to 6.9% in 2006 • Lowest in UE- 3.4% and highest in GAR – 10.5%

30. PNC Coverage

31. PMTCT • Number of sites trained 311 • Number of sites reporting ? • No. counselled & tested = 36,155 • No. positive = 1,378 (3.8%) • No. given Nevirapine = 1,239

32. HIV testing for pregnant women: Principal rule • Offer all pregnant women HIV testing as part of initial and subsequent ANC counselling • N/B • Routine offer of HIV test • Not routine HIV testing • Diagnostic counselling and testing.

33. HAART in HIV+ Pregnant Women • All HIV-infected pregnant women who meet national criteria for the initiation of HAART shall be provided HAART, according to national guidelines • i.e. first-line or alternate first-line triple combination treatment. • All HIV-infected pregnant women who do not meet national criteria for the initiation of HAART shall be provided combination therapy for preventing MTCT

34. PMTCT- cont… • All HIV-infected pregnant women shall be evaluated using the CD4 count. • All HIV positive pregnant women with <350 CD4 cell count, irrespective of clinical stage: • Treat with HAART. • All HIV positive pregnant women with 350 or more CD4 cell count • Start ARV prophylaxis

35. Prophylaxis Regimen for PMTCT • Regimen to be initiated from 28 weeks of pregnancy • For infant – from birth till one week postpartum

36. Cervical Cancer • In 2006, a total of 2,660 women were screened in the GAR and ASH regions • No. positive = 177 • Cryotherapy done = 126 • Out of 5 suspected Cx Ca cases in ASH region, 3 successfully had hysterectomy done

37. Activities carried Out • Assessment for CAC • PMTCT orientation meeting for all Regional public health nurses. • Adaptation of new WHO/CDC protocols on PMTCT • Completed disseminated audit system in the three northern regions • Trained 75 audit team members. • New ANC register completed distributed • Revised and printed new maternal Health Records (With Partograph) • Development of advocacy material for maternal health • Film on Ghanaian woman • SM film • Adaptation of why Mrs X died - ongoing

38. Activities carried Out • Continued development of RCH database • Regional planning meetings on the HIRD approach for Central region • PMTCT training for new sites in collaboration with NACP. • Reviewed the SM protocols – more illustrations, detailed guidelines • Finalized costing of the RH strategic plan

39. Key Challenges • Late reporting and incomplete reporting from regions • Shortage maternal health records books • Low supervised delivery and PNC coverage • Inadequate reporting on MVA and PAC activities –Some regions not submitting full reports on PAC • High maternal mortality rate • Late and incomplete reporting on maternal death notification • Low quality of maternal death audits in some regions • Very high still birth rate • Neonatal Death increasing

40. Key Challenges • Inadequate administrative support staff for the Unit

41. Way Forward • Registration of Misoprostol for obstetric care • Regional Planning Meeting on strengthening maternal health services • Expand cervical cancer screening services • Review labour ward registers • Disseminate Advocacy tool- REDUCE • TOT on neonatal resuscitation

42. Way Forward cont…. • Training and installation of RCH Database System • Implement pilot project- Improving maternal health using queen mothers • Adaptation of HBLSS guidelines for use in the country • Finalize and print reviewed National Safe Motherhood Protocols • Initiate the introduction of CEMD in country

43. THANK YOU

44. FAMILY PLANNING

46. Acceptor rate by regions

47. Acceptor Rate (Regional variations)

48. Couple Years of Protection

49. Method Preference • Depo Provera, the most preferred contraceptive method decreased from 46.0% in 2005 to 44.3% in 2006 • Uptake for the male condoms increased from 20.0% in 2005 to 22.1% in 2006, while the combined pill also increased form16.7% in 2005 to 18.1% in 2006 • The consistent decline in IUD uptake was however halted in 2005, increasing form 14,874 in 2005 to 15, 490