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Health, Water and Sanitation

Maternal mortality remains high in Ghana, currently estimated at 350 deaths per 100,000/live births and with the very slow progress, making it unlikely for Ghana to meet MDG 5. An independent assessment of the Health Sector in 2010 reported that “supervised delivery remains low and timely referral remains a problem in many districts, even if creative solutions are introduced at operational level; and costs or referral is outside the National Health Insurance Scheme package.

The acceptance rate and use of family planning remains also a challenge with a continuous drop in family planning uptake from 33.8% in 2003 to a low 23.5% in 2010”. According to the Ministry of health half year report for 2012 (Jan –June 2012), supervised delivery stood at 24.3% compared to 27.1% in 2011 for the same period. In the Brong Ahafo region, there appears to be an increasing trend in maternal mortality since 2010, increasing from 66 per 100,000 live births in 2010 to 76 in 2011 increasing further to 109 in 2012.

Most maternal deaths in Ghana have been attributed to delays in receiving professional care and experts indicate that increasing the proportion of supervised delivery delivered by midwives was crucial to reverse the trends in maternal mortality. Yet, close to half of all deliveries Ghana are unsupervised. Poor quality and inadequate health service delivery by public institutions coupled with distance to service centres and cost considerations all work to inhibit citizens’ access to health services especially in rural communities. According to the independent health sector review for 2010, poor staff attitude and unsatisfactory facilities were identified as key factors affecting delivery in facilities, next to cultural and other barriers.

Though evidence suggests that the quality and effectiveness of delivery of public goods and services can be greatly enhanced by improved transparency, accountability and collaborations among citizens and duty bearers, this collaboration and participation is undermined by the lack of capacity, appreciation of roles and awareness of rights both on the demand and supply sides of the delivery of public goods.

On the citizen side, community members are generally a) Unaware of the provision in the local government Act guiding the running of the districts Assemblies, b).Unaware of the contents of the district development plans and the provisions for the various sector and c) poorly equipped to meet with personnel of MMDAs and the service providers and demand quality delivery of services. Similarly officials of the MMDA and health service providers, are equally ill equipped to engage with community members, do not appreciate the value of collaborate with civic society groups and even where there is the desire to engage, there are no institutionalized platforms for such engagements.

Consequently there is little if any downward accountability to community members while their perception on quality and effectiveness of service delivery is hardly adequately incorporates in the planning or delivery process. Similarly there is practically no involvement or consultation of citizen in monitoring and assessing the quality and effectiveness of service delivery.

SODIA and its partners will to contribute to improving the effectiveness and quality of health service delivery particularly maternal health, in the Brong Ahafo Region by facilitating enhanced citizen participation in the planning and monitoring of health services. Effective collaboration between local government and citizens requires the awareness of community members of their rights, understanding the workings of the District /Municipal assemblies and the requisite skills to engage with duty bearers. On the other hand, there is also the need for the MMDA and other state stakeholders in health service delivery to appreciate the rights of citizen and the value of citizen participation in governance.