1. 1
Integration of Community Emergency Transport System
with repositioning Traditional Birth Attendants as Link
Providers improves skilled assisted childbirth in northern
Ghana
By Ane Adondiwo, EPPICS Project Manager
Double Tree Hotel
May 8, 2014

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Presentation Outline
• Introduction
• The Problem
• Interventions
• Performance Indicators
• Lessons Learned
• Conclusion
• Next Steps
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Introduction
Encouraging Positive Practices
for Improving Child Survival
(EPPICS) project targets
51,000 direct beneficiaries
Goal: To contribute to
reduction in maternal and
child morbidity and mortality
LOE: Maternal and newborn
care (60%), nutrition
(30%), and malaria (10%)
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4. 4
Why East Mamprusi?
MNCH/N Indicators EM, NR and National-
2010/11
East
Mampr
usi
Northern
Region
Ghana
Antenatal
visits (1st
trimester)
30 49 55
Antenatal
visits(4+)
46 58 78
Supervised
deliveries
48 38 46
IPT2+ 51 33 44
ITN use 36 45
Institutional
MMR
275 95 -
Under 5
Mortality
Rate
138 137 80
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EPPICS Strategies
• Quality Improvement Methods/Emergency Obstetric Care
• Council of Champions
• Healthy Mothers/Newborn Care Committees
• Pregnancy Surveillance
• Community Monitoring and Evaluation System
• Repositioning Traditional Birth Attendants(TBAs) as Link Provider
• Community Emergency Transport System(CETS)
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Facility-based Strategies
6
Quality Improvement Training Training on Emergency Obstetric
Care

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Community-based Strategies
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Council of Champions Healthy Mothers/Newborn Committees
Photos by CRS Field Officers

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Community-based Strategies
8
Pregnancy Surveillance
Photos by CRS Field Officers
Community Giant Scoreboard

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The Problem of Access to Health Services
1. Inability to recognize
the problem and
promptly seek care
2. Inability to reach
the point of care 3. Delay in receiving
appropriate and
quality care
60% of population in East Mamprusi have
no access to health facilities (live outside
5KM radius)

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How did EPPICS tackle the 2nd Delay?
Intervention # 1
Repositioning Traditional Birth Attendants(TBAs) as Link Providers
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Repositioning TBAs as Link Providers -
The Process
11
1. Identify Active
TBAs
2. Negotiate with
TBAs to get them
enrolled into
EPPICS
3. Provide
training/orientati
on to TBAs
including
logistics/supplies
4. Monitor and
supervise the
work of Link
Providers at the
community level
5.GHS and CRS
engage Link Providers
in Quarterly Reflection
meetings
Improve
access to
skilled
professionals
at health
facilities

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How did EPPICS tackle the 2nd Delay?
Intervention # 2
Community Emergency Transport System
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1. Assessment and
baseline data
collection
2. Mobilization and
sensitization of
community members
3. Formation of
Community Emergency
Transport Committees
(CETCs)
The Community Emergency Transport Process

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4. Training of CETCs
members &Identification
and training of
motorbikes and transport
owners
5. Collection and
provision phone #s of
ambulances and motor-
cycles/tricycles
The Community Emergency Transport Process

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Facilitating Community Emergency Transport
System - The Process
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Map out all
communities
outside 5 Km
2. Mobilize and
engage
communities on
various options
for emergency
transport
3. Facilitate the
formation of CETS
committees and
provide orientation
on
roles/responsibilities
4. Monitor and
supervise the
activities of CETS
members
5. Engage CETS
members in feedback
sessions
Improve
access to
skilled
professionals
at health
facilities

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Key outcome of the combined interventions
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Outcome of Interventions
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48
86
0
10
20
30
40
50
60
70
80
90
100
Baseline-2011 Mar.2014
Percent
Skilled Assisted Deliveries at Baseline and Mar.2014

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Other key improvements in the maternal and
newborn health indicators
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Process Improvements - Referrals
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Langbisi Gambaga Nalerigu Sakogu Gbintiri
Current status 56 30 59 40 37
Baseline 9 24 8 14 8
0
10
20
30
40
50
60
70
80
Percent
Referral of mothers and newborns linked to CETS and Link Providers
Oct.2011-Mar.2014

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Lessons Learned
• Effective integration, community mobilization and
empowerment are necessary for sustainability
• Recognition, adoption and scale up by government and
other NGOs will increase investment and access to health
services
• The two strategies have the potential of accelerating a
reduction in maternal and newborn deaths
• Health workers relationship with community members
improved
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Challenges
• Human resource
-limited number of trained personnel
-Staff attrition due to lack of social amenities
• Role of other non-governmental organizations
• Dwindling allocation of government funding
• No expansion in physical infrastructure

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Next Steps
• CRS with funding from Helmsley Charitable Trust has
started scaling up CETS in six districts through a
project dubbed “Rural Emergency Health Service
and Transport” (REST)
• Finalize guidelines and reference manuals for
scaling up CETS
• Work with the Ghana Health Service and other
project partners/stakeholder to scale up CETS and
Link Provider strategies
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Conclusions
Based on the positive lessons learned:
 CETS and Link Providers achieved the objective of
helping to address the challenge of inability to reach
the point of care on timely basis and;
 CETS and Link Provider designs could pass as
interventions that should be adopted as part of
Millennium Accelerated Framework for maternal
health in most districts with limited access to health
facilities
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THANK YOU

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Acknowledgment:
• USAID
• Project Implementation Partners: Ghana Health Service and
University for Development Studies
• Chiefs and people of East Mamprusi District. Ghana
• The Catholic Diocese of Navrongo Bolgatanga, Ghana
• EPPICS Field Officers
For more information contact: Mohammed Ali, Health Program
Manager, email: mohammed.ali@crs.org
or Ane Adondiwo, EPPICS Project Manager
email:ane.adondiwo@crs.org