By Rachel Kakraba
Implementation of Group Antenatal Care and Delivery Project in some selected health facilities in Ghana has seen an increase in antenatal attendance. The initiative which commenced in 2018, is touted to have also significantly improved the general well-being of pregnant women and newborns. Through the initiative, expectant mothers are sensitized on how to detect danger signs in pregnancy, birth preparation and Complication readiness. The trial of the project in 14 selected health facilities in the Eastern Region, was implemented by the University of Michigan in the United States and the Dodowa Health Research Centre in Ghana. It was to assess the impact of Group Antenatal Care for possible incorporation into Ghana’s healthcare delivery.
The trial was conducted under the Group Antenatal Care Delivery Project (GRAND), which is a five-year, Cluster Randomized Controlled Trial (RCT). Under the project women with similar gestational ages of pregnancy were grouped into small groups at the first ANC visit, the same group meets the same midwife at the recommended intervals for care. This is a departure from routine ANC, which is attended by pregnant women at all stages and with different healthcare workers.
Speaking at a dissemination workshop which discussed research findings of the project in Accra, the Director Family Health Division, Ghana Health Service, Dr. Kofi Issah lauded the contribution of the project which he said has improved health outcomes in maternal healthcare. He said the country is on course in sensitizing expectant mothers to be abreast of unhealthy practices which are detrimental to their lives and that of their babies as well as how to care for their newborns. He said antenatal care has a positive impact on not only mothers and their babies but the entire family and communities.
“Antenatal care is critical for producing positive health outcomes not only for pregnant women and their children but for families and communities. For those of us who are old enough, antenatal has always featured in the interventions that we have provided”
Dr. Issah said the research findings will improve policy intervention on maternal health.
“It has come to stay, it’s not really good on our part as service delivery providers for someone to come in few years or months later to ask why are you not doing Group antenatal care, for you to say well the grant project has ended and that’s why we have gone back to business as usual. It shouldn’t be business as usual, but to take the findings, feed it into policy and replicate it elsewhere”
The PI of Michigan University, Professor Jody Lory, regretted about the high maternal mortality rate in Ghana and hoped the findings of the project will help reverse the trend.
“The next step is to look at all the evidence together and put the Ghana Health Service and Policy makers together to think about how to proceed in the way antenatal care is delivered in Ghana”
She said under the project knowledge has been increased amongst pregnant women, adding it has also improved communication and connection between pregnant women and midwives.
“Our major finding is that it improved communication between women and their providers and it improved that connection between women and midwives when they receive antenatal care in a group. They also had a lot of peer support so they had support from the other groups of same gestational age, so they could share information”
The country lead for the GRAND project, Dr. John Williams said the high illiteracy rate amongst pregnant women to retain relevant information at Antenatal clinic necessitated the introduction of Group Antenatal Care (G-ANC). He said its implementation in the last five years has helped pregnant women to be well informed about danger signs in both mothers and their newborns. It has also taught them how to prepare for emergencies in birth. Dr. John Williams said the project has seen significant improvement in infant mortality rate.
“It’s been quite established that low levels of health literacy actually increase the cost of healthcare by 25 percent annually”
Adding on he said “our objective for this sub-study was to examine women’s understanding of health messages, their appraisal of health information in their engagement with the health system”
A member of the research team, Dodowa Health Research Centre, Madam Vida Ami Kukula, said Birth Preparedness and Complication Readiness (BPCR) among pregnant women has been a challenge, however, the group Antenatal Care has helped improve the health of mothers and Newborns. She also said it has increased the knowledge of parents on the danger signs in pregnancies and Newborns.
“One interesting thing about the Group Antenatal Care is the use of the picture cards which was very striking even for those who cannot read and write the picture cards was very important to them. So it helped them to remember what the midwife said to them”
She added “At the end of the day we expect all the mothers to be able to receive all this information at the antenatal clinic. So we have to make sure that the mothers watch out for danger signs, arranging for emergency transport when the time is due. Saving money for birthing and postnatal, having valid health insurance identifying a place for delivery, identifying a travel companion, a blood donor, self-caring and identifying someone to care for the home when they go into labour”
Some women who have been beneficiaries of the project expressed appreciation to the team and hoped it will be sustained for the benefit of other women.
