Primary Health Care in rural Ghana is constraint with requisite tools and resources as a result of inequalities that exist in the health sector. Many women die at childbirth or even before reaching the health facilities due to what is known technically as the “three delays”- deciding to seek care, reaching the health care facility and receiving timely care.  In Ghana, Maternal mortality is the second leading cause of female mortalities accounting for 14% of all female deaths.

Mercy Appiah a 32-year-old at Krobo-Manhyia says she was fortunate to have survived the incidence which nearly claimed her life. “At 12 am my water broke, my sister called a cab driver who lives 20 miles away from my residence. We couldn’t get the cab and I had to use “aboboya- the tricycle”. The car got stuck on the hills because the roads are not motorable after it rains. I had to alight from the “car” and walk for it to be pushed in my pain. That time I felt my baby’s head was almost coming out but I could not go through vaginal delivery because I had complication as a result of delay and the stress I went through on the road; she said.

Currently, Ghana's maternal mortality ratio is at 308 per 100 000 live births. Literature on the country’s Maternal Health Survey (GMHS) suggested that about 75% of maternal deaths are linked to direct obstetric factors.

Obstetric Gynecologist Benedict Affare in Accra says these direct causes of maternal mortality are postpartum hemorrhage, sepsis, pre-eclampsia, and eclampsia, birth complications and unsafe termination of pregnancy within 42 hours. As such, delay in seeking care comes with various consequences;  either the mother dies or the baby as a result of delay but these causes can be curtail with effective education on pregnancy related issues.   

“These direct causes of maternal mortality can be address but through a vibrant primary health care system and effective education on pregnancy related issues”.

Available literature by Kwesi Frimpong, on “Emerging issues in public health: a perspective on Ghana’s healthcare expenditure, policies and outcomes,” financial malfeasance, lack of commitment towards the country’s primary health care delivery are major hurdles. “The major challenges Ghana’s health sector is fraught with are low-level priority and financial mismanagement. Though the Ministry of Health has reported increments for the sector in the last few years but those increments are not reflective of the current situation in rural Ghana”.

For Health Economist, Gordon Abekah–Nkrumah, there ought to be an investment in education to defeat socio-cultural barriers that bars women from seeking care and the road networks that connect these health centers in rural communities. “Investing in women’s education to enable them understand their rights and make informed decisions about their health and in road networks that connect these communities and health facilities to access care, will improve maternal mortality significantly”.

Before 2000, it was estimated that between 540 and 650 mothers died for every 100,000 live births in Ghana. With this high mortality rate, the Ghana Health Service implemented a number of policies including the antenatal care policy, the safe motherhood initiative and the delivery exemption policy to reduce the financial constraints associated with access to care through the NHIS. Ghana has performed well in reducing maternal mortality as compared to other countries in the sub-region, but there are still a lot to do.

However, the director of monitoring, planning and evaluation at the GHS, Koku Awonoor -Williams asserts removing cost is only one part of addressing maternal death because there are still issue of limited staffs, systemic issues to work at delivering quality care. “Working in rural Ghana, I appreciate the cost factor, but that is just one part of the challenges. Issues of policy implementations need to be addressed together with the demand for toiletries such as soap, T-roll, Dettol etc from patients is deterring the dying women from seeking care.”