Date of Defense:
September 16, 2013
Objectives: To assess the association between maternal care and healthcare provider type in Ghana, so as to better inform prioritization of health worker capacity building efforts.
Methods: An analysis of maternal care by antenatal provider type using the cross- sectional 2008 Ghana Demographic and Health Survey. Study population included rural Ghanaian women age 15-49 years with report of a live birth in the five years preceding the survey. Bivariate chi-square analysis was performed to examine differences by antenatal provider type in maternal report of WHO-recommended Maternal Health Interventions. Multivariate linear and logistic regressions were performed to assess the effect of provider type on antenatal care (ANC) scales and maternal care packages.
Results: 1,367 rural women reported a live birth in the five years preceding the survey. Provider distribution included: doctor, 15.6%; midwife, 70%; community health officer (CHO), 9.1%; and no provider, 5.3%. Women who reported receiving care from a doctor were from the highest sociodemographic profiles. Report of ANC from a CHO, as compared to reporting no provide r, was significantly associated with report of maternal services. Report ANC from a doctor or midwife, as compared to a CHO, was significantly associated with report of maternal services.
Conclusion: There are differences in maternal car e between skilled provider categories. The largest gap in report of care lies between skilled providers and no providers. Health system strengthening efforts require increased information on health workforce activities to best inform training priorities and resource allocation.