Emergency Obstetric And Newborn Care,2011
Second Round
Ghana, 2011
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Reference ID
GHA-GSS-EmONC-2011-V1.0
Producer(s)
Ghana Health Service
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Metadata
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Sep 12, 2014
Last modified
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Identification
Survey ID Number
GHA-GSS-EmONC-2011-V1.0
Title
Emergency Obstetric And Newborn Care,2011
Subtitle
Second Round
Translated Title
No translation
Country
| Name | Country code |
|---|---|
| Ghana | GHA |
Study type
Living Standards Measurement Study [hh/lsms]
Series Information
An EmONC assessment to determine the capacity of the existing health care delivery systems in the country. The assessment in both public and private sector in the country is timely because of the ongoing health systems changes in Ghana. Again information supporting policy debates and programming to improve quality of health services is scarce dating back in 2005 when the first round was conducted. Then it was a limited facilities were assessed in the three Northern regions in the country.
Abstract
The Ghana EmONC assessment was a national cross-sectional facility-based survey that utilized 11 modules as data collection instruments. Data collection began April 28th and concluded June 4th, 2010 in Upper East Region. For all other regions, data collection began July 25th and concluded by 7th September 2010. A total of 1,268 facilities were visited, of which 1159 performed a delivery in the 12 months before the survey. Out of 1,268 facilities surveyed, 3 were Teaching hospitals, 9 Regional hospitals, 273 District and Other hospitals, 518 Health centres, 161 Health clinics, 165 Maternity homes and 139 CHPS Compounds.
For most regions, the sample of health care facilities was a census of all hospitals (Teaching, Regional and District) and all health centers, health clinics, maternities and CHPS compounds that recorded at least 5 deliveries per month in the HMIS for 2009. For the three regions that make up the North (Northern, Upper East and Upper West Regions), inclusion criteria differed. In the UER, all health facilities above the CHPS level that performed any deliveries in the previous year were included and a random 30% sample of CHPS facilities was visited, regardless of the number of deliveries performed. In Northern and Upper West regions, facilities conducting at least one delivery per month (on average) were visited.
The Ghana Statistical Services was contracted to manage the data entry and to conduct analysis. The GSS developed data entry screens in CSPro 4.0 and double data entry was performed between August and December 2010. The data files were exported into SPSS 13 and STATA 10 for analysis. GSS and AMDD shared analysis tasks. Data for service availability mapping was provided by GHS. Report writing began in July 2011, led by a consultant hired to coordinate the report writing process. Data analysis and report writing involved extensive collaboration and participation of the steering group with continued AMDD support
For most regions, the sample of health care facilities was a census of all hospitals (Teaching, Regional and District) and all health centers, health clinics, maternities and CHPS compounds that recorded at least 5 deliveries per month in the HMIS for 2009. For the three regions that make up the North (Northern, Upper East and Upper West Regions), inclusion criteria differed. In the UER, all health facilities above the CHPS level that performed any deliveries in the previous year were included and a random 30% sample of CHPS facilities was visited, regardless of the number of deliveries performed. In Northern and Upper West regions, facilities conducting at least one delivery per month (on average) were visited.
The Ghana Statistical Services was contracted to manage the data entry and to conduct analysis. The GSS developed data entry screens in CSPro 4.0 and double data entry was performed between August and December 2010. The data files were exported into SPSS 13 and STATA 10 for analysis. GSS and AMDD shared analysis tasks. Data for service availability mapping was provided by GHS. Report writing began in July 2011, led by a consultant hired to coordinate the report writing process. Data analysis and report writing involved extensive collaboration and participation of the steering group with continued AMDD support
Kind of Data
Sample survey data [ssd]
Unit of Analysis
All Health Facilities that Perform Delivery
Version
Version Description
Version 1.0 (September, 2014)
Version Date
2011-09-12
Version Notes
The survey was nationally conducted in August, 2012 and the previous was conducted in three sellected northern region
Scope
Notes
Ghana is a tropical country on the west coast of Africa with three geographic zones; dry northern savanna, the humid middle forest rainfall zone and the coastal savannah and mangroves. It is bounded on the West by Ivory Coast, east by Togo, North by Burkina Faso and the Gulf of Guinea on the South. It lies between Latitudes 5º and 11º North of the Equator and between longitudes 1º East and 3º West of the zero meridian. The country area is 238,537 sq km and has 550 kilometres coastline. The ambient temperature is between 21 and 32 degrees Celsius.
The questionnaires for the Generice EmONC were structured questionnaires based on the EmONC Model Questionnaire with some modifications and additions. Models 1-11 were used as listed below:
MODULE 1: IDENTIFICATION OF FACILITY AND INFRASTRUCTURE
MODULE 2: HUMAN RESOURCES
MODULE 3: ESSENTIAL DRUGS, EQUIPMENT, AND SUPPLIES
MODULE 4: FACILITY CASE SUMMARY
MODULE 5: EmOC SIGNAL FUNCTIONS ANDOTHER ESSENTIAL SERVICES
MODULE 6: PARTOGRAPH REVIEW
MODULE 7: PROVIDER KNOWLEDGE AND COMPETENCY FOR MATERNAL AND NEWBORN CARE
MODULE 8: CESAREAN REVIEW
MODULE 9: REVIEW OF MATERNAL DEATHS
MODULE 10: REVIEW OF NEONATAL DEATHS
MODULE 11: REFERRAL FOR OBSTETRIC, NEWBORN AND OTHER PATIENTS
The questionnaires for the Generice EmONC were structured questionnaires based on the EmONC Model Questionnaire with some modifications and additions. Models 1-11 were used as listed below:
MODULE 1: IDENTIFICATION OF FACILITY AND INFRASTRUCTURE
MODULE 2: HUMAN RESOURCES
MODULE 3: ESSENTIAL DRUGS, EQUIPMENT, AND SUPPLIES
MODULE 4: FACILITY CASE SUMMARY
MODULE 5: EmOC SIGNAL FUNCTIONS ANDOTHER ESSENTIAL SERVICES
MODULE 6: PARTOGRAPH REVIEW
MODULE 7: PROVIDER KNOWLEDGE AND COMPETENCY FOR MATERNAL AND NEWBORN CARE
MODULE 8: CESAREAN REVIEW
MODULE 9: REVIEW OF MATERNAL DEATHS
MODULE 10: REVIEW OF NEONATAL DEATHS
MODULE 11: REFERRAL FOR OBSTETRIC, NEWBORN AND OTHER PATIENTS
Topics
| Topic | Vocabulary |
|---|---|
| Health | Ghana Health Service |
Coverage
Geographic Coverage
National
Ghana is divided into ten administrative regions and 170 decentralized districts. The districts are subdivided into area councils (political divisions) and 5-8 sub-districts (Health divisions) and these sometimes overlap. The sub-districts are subdivided into CHPS (Community-based Health Planning Services) Zones.
The total population is 24,232,431 with a population density varying from 897 per km2 in Greater Accra Region to 31 per km2 in the Northern Region. About 70% of the population lives in rural areas. Women of fertile age (15-49 years) account for 24% of the population, adolescents (10-19 years) XXX% and the youth (15-24 years) XXX%. The crude birth rate is 28.6 per 1,000 population and the crude death rate is 9.4 per 1,000 population. Population growth rate 2.4%, total fertility rate (children born per women) and Life expectancy is estimated at 56 years for men and 57 years for women. Adult literacy rate (age 15 and above) is 65%. Each sub-district has 20,000-30,000 people and a district 80,000-150,000 population.
Ghana is divided into ten administrative regions and 170 decentralized districts. The districts are subdivided into area councils (political divisions) and 5-8 sub-districts (Health divisions) and these sometimes overlap. The sub-districts are subdivided into CHPS (Community-based Health Planning Services) Zones.
The total population is 24,232,431 with a population density varying from 897 per km2 in Greater Accra Region to 31 per km2 in the Northern Region. About 70% of the population lives in rural areas. Women of fertile age (15-49 years) account for 24% of the population, adolescents (10-19 years) XXX% and the youth (15-24 years) XXX%. The crude birth rate is 28.6 per 1,000 population and the crude death rate is 9.4 per 1,000 population. Population growth rate 2.4%, total fertility rate (children born per women) and Life expectancy is estimated at 56 years for men and 57 years for women. Adult literacy rate (age 15 and above) is 65%. Each sub-district has 20,000-30,000 people and a district 80,000-150,000 population.
Universe
Health facilities that do delivery
Producers and sponsors
Primary investigators
| Name | Affiliation |
|---|---|
| Ghana Health Service | Government of Ghana |
Producers
| Name | Affiliation | Role |
|---|---|---|
| Ghana Statistical Service | Government of Ghana | Technical Assistant |
| Averting Maternal Death and Disability | WHO | Technical Assistant |
Funding Agency/Sponsor
| Name | Abbreviation | Role |
|---|---|---|
| United Nations Children's Fund | UNICEF | Financial Contributer |
| United Nations Population Fund | UNFPA | Financial Contributer |
| World Health Organization | WHO | Financial Contributer |
| United States Agency for International Development | USAID | Financial Contributer |
Sampling
Sampling Procedure
A total of 1,268 health facilities in both the public and private sector (for-profit and not-for-profit) were included were visited, of which 1159 performed a delivery in the 12 months before the survey. Since the focus of the assessment was obstetric and newborn care, health facilities that do not offer maternal health services were not targeted.
NOTE: In Upper East Region, data collectors reviewed all maternal deaths that occurred in the last year. However, for consistency of analysis, only the three most recent maternal deaths were included in the analysis for this report.
NOTE: In Upper East Region, data collectors reviewed all maternal deaths that occurred in the last year. However, for consistency of analysis, only the three most recent maternal deaths were included in the analysis for this report.
Deviations from the Sample Design
Not reported
Response Rate
Response Rate of the survey was 91.4%
Weighting
No weight attached
Data Collection
Dates of Data Collection
| Start | End | Cycle |
|---|---|---|
| 2011-04-28 | 2011-09-07 | 5 Months |
Time periods
| Start date | End date | Cycle |
|---|---|---|
| 2011 | 2015 | 5 Years |
Data Collection Mode
Face-to-face [f2f]
Supervision
GHS identified a staff person to coordinate the implementation of the assessment. This person was responsible for recruiting the data collectors, organizing and managing the field work, ensuring adequate logistics and transportation planning, determining the routes the teams would take to visit facilities, managing and oversight of data collection teams in the field, and communication with data collection teams and health facilities to ensure access to facilities. The GHS issued a letter to all public and private facilities requesting their support in the national EmONC assessment. Field work began immediately after data collector training.
Data Collection Notes
The Ghana Statistical Services was contracted to manage the data entry and to conduct analysis. Twenty data entry staff were hired and trained in early August. The GSS developed data entry screens in CSPro 4.0 and double data entry was performed between August and December 2010. GSS staff carried out some preliminary cleaning of the files and sent them to AMDD for further cleaning. Cleaning continued throughout the process of preparing preliminary findings.
Data Collectors
| Name | Abbreviation | Affiliation |
|---|---|---|
| Ghana Health Services | GHS | Ministry of Health |
Questionnaires
Questionnaires
The questionnaires for the Generice EmONC were structured Eleven different questionnaires based on the EmONC Model Questionnaire with some modifications and additions. Models 1-11 were used as listed below:
Module 1: Identification of Facility and Infrastructure
Module 2: Human Resources
Module 3: Essential Drugs, Equipment, and Supplies
Module 4: Facility Case Summary
Module 5: EmONC Signal Functions and other Essential Services
Module 11: Referral for Obstetric, Newborn and other Patients
Module 6: Pantograph Review
Module 7: Provider knowledge and competency for Maternal and Newborn Care
Module 8: Cesarean Review
Module 9: Review of Maternal Deaths
Module 10: Review of Neonatal Deaths
Module 1: Identification of Facility and Infrastructure
Module 2: Human Resources
Module 3: Essential Drugs, Equipment, and Supplies
Module 4: Facility Case Summary
Module 5: EmONC Signal Functions and other Essential Services
Module 11: Referral for Obstetric, Newborn and other Patients
Module 6: Pantograph Review
Module 7: Provider knowledge and competency for Maternal and Newborn Care
Module 8: Cesarean Review
Module 9: Review of Maternal Deaths
Module 10: Review of Neonatal Deaths
Data Processing
Data Editing
The Ghana Statistical Services was contracted to manage the data entry and to conduct analysis. Twenty data entry staff were hired and trained in early August. The GSS developed data entry screens in CSPro 4.0 and double data entry was performed between August and December 2010. GSS staff carried out some preliminary cleaning of the files and sent them to AMDD for further cleaning. Cleaning continued throughout the process of preparing preliminary findings.
The data files were exported into SPSS 13 and STATA 10 for analysis. GSS and AMDD shared analysis tasks.
The data files were exported into SPSS 13 and STATA 10 for analysis. GSS and AMDD shared analysis tasks.
Other Processing
Facility fact sheets were developed by AMDD and were presented in April 2010 at the Health Summit. Preliminary results tables were developed by GSS and AMDD and discussed in an analysis planning workshop in March 2011. Attending the workshop were members of the Ministry of Health/GHS, KNUST and University of Ghana School of Public Health, GSS, AMDD and an international consultant.
Data Appraisal
Estimates of Sampling Error
Facility records of deliveries, obstetric complications, cesareans and deaths (maternal and newborn) are often incomplete. In particular, maternal deaths due to indirect causes are not likely to be found in the maternity or gynecological wards. Furthermore, not always will the pregnancy status of a woman who dies of hepatitis, for example, be prominently displayed in a logbook or register.
Complications are frequently under-recorded and therefore “Met Need for EmONC” may be underestimated; under-recording of complications (and deaths) also will impact the direct obstetric case fatality rate. Misclassification of stillbirths and very early neonatal deaths may occur because staff feels unjustifiably guilty about the death of a newborn and will therefore classify it as a stillbirth. Or staff may not want to tell a mother that her newborn was born alive and then died
Complications are frequently under-recorded and therefore “Met Need for EmONC” may be underestimated; under-recording of complications (and deaths) also will impact the direct obstetric case fatality rate. Misclassification of stillbirths and very early neonatal deaths may occur because staff feels unjustifiably guilty about the death of a newborn and will therefore classify it as a stillbirth. Or staff may not want to tell a mother that her newborn was born alive and then died
Data Appraisal
No other
Access policy
Contacts
| Name | Affiliation | |
|---|---|---|
| Dr. Patrick Kuma- Aboagye | Ghana Health Service | |
| Appiah-Kusi Boateng | Ghana Statistical Service | kusi.appiah@statsghana.gov.gh |
| Samilia Mintah | Ghana Statistical Service | samilia.mintah@statsghana.gov.gh |
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Access conditions
The Ghana Statistical Service as a public institution has the obligation to promote data dissemination to facilitate national development. Making mcrodata available will enable students and the academia to conduct research works, assist investors to take business decision, help the individual to evaluate and take appropriate decisions. It will also assist the government to formulate appropriate policies and programmes to facilitate national development. GSS' policy framework provides access to data through:
Citation requirements
Ghana Health Services, Emergency Obstetric And Newborn Care (EmONC)- 2011 version1.0
Access authority
| Name | Affiliation | URL | |
|---|---|---|---|
| Govenment Statistician | Government of Ghana | info@statsghana.gov.gh | Link |
Disclaimer and copyrights
Disclaimer
The original collector of the data, GSS and any producers or sponsors cited in this document bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Copyright
(C) 2014, Ghana Statistical Service
Metadata production
DDI Document ID
DDI-GHA-GSS-EmONC-2011-V1.0
Producers
| Name | Abbreviation | Affiliation | Role |
|---|---|---|---|
| Ghana Statistical Service | GSS | Government of Ghana | Metadata Producer |
Date of Metadata Production
2014-09-12
DDI Document version
Version 1.0 (September, 2014)