On 12th April, 2010, I joined Oxfam and some international media personnel to travelled from Accra to Bolgatanga in the Upper East Region of Ghana. The visit was a familiarization tour to acquaint ourselves with impact of maternal health care at the region.

With a population of 1.1 million, Upper East Region has only five Hospitals in the nine Districts with a Doctor to patient population ratio as 1 – 34000. The Regional Hospital has two and half Medical Practitioners delivering health care and the “half person” happens to be the Regional Health Director Dr. Koku Awoonor-Williams who leaves his administrative duties to attend theater for surgery every Thursdays.

The Regional Hospital alone receive about 600 patience daily from 6:00am to 10:00pm and with this revelation, the Regional Health Director said patience has been complaining of the long waiting at hospital which are quite understandable.

Since seven years, almost 57 health practitioners posted at the region have failed to report to duty and rather working at the Southern parts of the country.

Some of the reasons putting which are off most health workers posted at the region cite lack of social network, inadequate infrastructure, may not get first class schools for their wards, proximity, inadequate launch as compared in the cities, and many more.

It is government Health Care Policy to provide every District in the country a District Referral Hospital that constitutes the main referral point for all Districts. However, the Upper East Region with only five hospitals in the nine Districts have major challenges with Referrals hence they refer on motorbikes, bicycles, donkey carts, ambulances, trucks.

Basically, it’s because of the nature of roads at the communities and the dispersed nature of how people live at the region. The buildings are much clustered and if it rains one will find it difficult in identifying a building.

In spite of the fact that the Upper East Regional Directorate of Health Services faces numerous logistical and staff challenges it’s noted to be the best practicing health institution in the country. Through the Regional Health Director`s leadership they have established Community Health Planning Services (CHPS) to provide sufficient health delivery to people in deprived areas at their doorsteps .

The region has made remarkable reduction at maternal and infant mortality cases and achievement of high nutritional supplementation for malnourished children.
It is the only region in the country to have achieved the fifth target of the Millennium Development Goals (MDGs) of reducing maternal mortality by three-quarters.

With this, many Africa countries such as Burkina Faso,Nigeria comes to the region and learn to replicate the knowledge acquired in their various countries.

In an exclusive interview with this reporter the Regional Director of Health Services Dr. Koku Awoonor-Williams said the health care system at the region has no problem but rather enormous challenges. He was quick to add the region is doing their best to address those challenges.

Dr. Awoornor-Williams said statistics are the same at the three Northern Regions; in Northern Region doctor to patience ratio is 1-93,000, Upper East doctor to patience ration is 1-34,000 and at Upper West doctor to patience ratio is also 1-43,000 and that is a major concern in terms of human resource and commensurate equipment that people are satisfied.

He said there are few equipment at theater as compared to some other hospitals in Southern part of the country but if all logistics are provided one would not be worried to work at any part of the country and within two hours could be out of theater.

“It only becomes worrisome when one needs to tight every knot, bleeder at theater that takes 6 hours then I get frustrated and may not come to the North. So it’s a combination of major factors and these are the kind of things that made people stay at the South than coming to the North” he said.

According to him the region has made tremendous progress on maternal mortality with 32 maternal cases recorded a year ago. “540 per 100,000 maternal cases were recorded in 1974 and as at 1994 our maternal mortality recorded were between 600 -800 per 100,000 life births at Navrongo Hospital.”

According to the Regional Health Director, the Free Maternal Health Care Scheme has improved the encounter of patience with health care delivery.Adding,with population of 1.1million, as at the year 2009,71 percent of the population had been insured by the National Health Insurance Scheme (NHIS) therefore one could access health care delivery anytime.

“In 2009, our OPD per capital is 1.3 which means that if you take the entire population each single person attends hospital 1.3 times. So health services encounter with the population is increasing and you don’t see this kind of things in other pars of the country”. Dr. Awoonor said.

He said the Regional Health care is making progress and at the end, those improvements are showing at the health indicators. “We are now worried with under five mortality but we are making progress to address that”.

He said the NHIS in Ghana which are being financed through tax could be described as social insurance which has come to alleviate the people. “Before the introduction of the NHIS our OPD per capital attendance is about 0.34percent and within a matter of five years it rose to 1.34percent which means people are able to reach a health care provider at point in time when they need services and that is very good.”

“The other question is does this reflect on the quality of service they are getting?” He asked in rhetoric. Adding “If you have a situation where more people are attending facility and if there is no commensurate increase in number of staff the work load on staff will increase and definitely if you go to OPD and see 100 patience a day, next you see 300 patience your output will be compromise because at a point in time you get tired”.

“So we are worried about quality health care and there are only nine clinical medical practitioners in the region and I myself go to the theater for surgery every Thursday.Becuase doctor to patience ratio are very terrible” he said.

With all these numerous challenges ,Dr. AWoonor-Williams is optimistic that the profession is a “calling that at a point in time one need to do self assessment and say I want to do the service, do your path and ,move on. If we all as a country do that we will be getting somewhere”.

However, he was quick to add that “people has the right to choose where they want to work”.
Not withstanding, the Regional Health Director said they are developing strategic system to attract and retain health physicians and also commended who have been committed to grant their service to the region.

Summing up Dr. Awoonor-Williams said to curb maternal mortality there is the need to improved maternal referral system, train health care providers’ life saving skills, study your laboratory services and improve adequately upon family planning.


Story: Daniel Nana Aforo