Peter W. Gething|Fiifi Amoako Johnson|Faustina Frempong-Ainguah|Philomena Nyarko|Angela Baschieri|Patrick Aboagye|Jane Falkingham|Zoë Matthews|Peter M. Atkinson
Geographical access to care at birth in Ghana: a barrier to safe motherhood
University of Oxford|University of Southampton|University of Southampton|University of Ghana|Ministry of Food and Agriculture|University of Ghana|University of Southampton|Ghana Health Service|University of Southampton|University of Southampton|University of Southampton
appropriate facilitybased care birth key determinant safe motherhood geographical access remains poor many high burden regions despite importance geographical access rarely audited systematically preventing integration nationallevel maternal health system assessment planning study develop uniquely detailed set spatiallylinked data calibrated geospatial model undertake nationalscale audit geographical access maternity care birth ghana highburden country typical many subsaharan africawe assembled detailed spatial data population health facilities landscape features influencing journeys used geospatial model estimate journeytime women childbearing age wocba nearest health facility offering differing levels care birth taking account different transport types availability calibrated model using data actual journeys made women seeking carewe found third women 34 ghana live beyond clinically significant twohour threshold facilities likely offer emergency obstetric neonatal care emonc classed partial standard better nearly half 45 live distance comprehensive emonc facilities offering lifesaving blood transfusion surgery remote regions figures rose 63 81 respectively poor levels access found many regions meet international targets based facilitiespercapita ratiosdetailed data assembly combined geospatial modelling provide nationwide audits geographical access care birth support systemic maternal health planning human resource deployment strategic targeting current international benchmarks maternal health care provision inadequate purposes fail take account location accessibility services relative women serve