Building Bridges for Maternal Health Benefit: A Realist Evaluation of Community to Point of Care (CPC) Strategy to Improve Maternal Health Continuum of Care in Rural Districts of Northern Ghana.

Building Bridges for Maternal Health Benefit: A Realist Evaluation of Community to Point of Care (CPC) Strategy to Improve Maternal Health Continuum of Care in Rural Districts of Northern Ghana.

Mohammed Ali

Continuum of care (CoC) is widely accepted and well documented as a safe motherhood strategy with dual benefits to mothers and their babies. Community to care point (CPC) strategy was integrated into community based health planning and services (CHPS) compounds in 30 rural communities northern Ghana to improve CoC service delivery and usage. Using a realist approach, this study evaluated the effect of the CPC strategy on CoC completion rates among mothers of children under five years. A mixed method cross sectional study was conducted at baseline (March 2014) and at endline (June 2017), a total of 845 women who experienced live births with infants were interviewed about maternal health service usage along the CoC pathway. Multiple logistic regression models were used to assess factors associated with CoC completion. The study showed that CoC completion rate increased from 16.8% at baseline to58.6% at endline. Factors associated with CoC completion rates included, education (OR =2.28; 95%CI 1.64 – 3.83), transport (OR = 3.96; 95%CI 1.02 – 4.96); geographic location (OR= 4.12; 95%CI 2.10 – 5.16) and being part of MCH education group (OR = 3.96; 95%CI 1.02– 4.96). The risk of non-completion of CoC services included being multiparous mother (RR=1.28; 95%CI 0.64 -1.83); use of commercial vehicles to access health facilities (RR =2.48; 95% CI 1.16 – 3.54) and being single mothers (RR = 1.45; 95% CI 0.55 – 3.71). Also, reasons for non-completion of CoC services included high poverty levels, seasonal flooding and limited hospitals to contain referrals from CHPS compounds. The findings suggest that the CPC strategy contributed to improving CoC completion rates among mothers in the study area. Further research on the cost effectiveness of the CPC strategy is required to inform its adoption by health policy makers and implementers as part of the CHPS program.
Key words: maternal health, continuum of care, community, rural, Ghana

Doctor of Philosophy (PhD) In Health Care Management

Ghana Technology University Library

August 2018