Promoting maternal and child health knowledge and practices through a network of female volunteers in Ghana
High impact of the mother clubs
De Kevi Evans
A health workforce of adequate size and skills is critical to the attainment of any population health goal. However, countries at all levels of socioeconomic development face, to varying degrees, difficulties in the education and training, deployment, retention and performance of their health workforce (WHO, 2016). Shortage of skilled health staff and the lack of the right mix of health care providers in the right place with the right resources is seen as serious bottleneck to providing quality health services. According to WHO, Africa, which is one of the world’s poorest regions and which also have the greatest burdens of preventable disease, unfortunately have the lowest density of health workers (2.2 health workers per 1000 population), (WHO, 2016). The involvement of community health workers to bridge the gap between the communities, caregivers and the formal health system is now an established approach, particularly where there is inadequacy of skilled health staff and also to increase access to health services in ‘last mile’ communities.
In Ghana, maternal and child morbidity and mortality are major public health concerns and remains the top heath priorities of Ghana’s Ministry of Health. The three northern regions of Ghana have the worst maternal, neonatal and child health (MNCH) statistics (GSS et al, 2015). The nationwide institutional maternal mortality ratio stood at 144,7 per 100’000 live births in 2017 (GHS, 2017). Additionally, the maternal mortality ratio from the general population was 308 per 100’000 livebirths and a lifetime risk of maternal death of 1 in 82 (GHS, 2020). In 2017, Institutional maternal mortality rate in Northern Region and Upper East Region where the project operates stood at 162.3/100’000 and 137.7/100’00 respectively (GHS 2017). These poor MCH indicators have been blamed on weak health systems as well as limited community participation and other socio-cultural factors that negatively affect the uptake of available healthcare services.
Many communities in Ghana live far away from health care facilities with limited access to health services. Many pregnant mothers refuse uptake of antenatal care services and facility delivery due to long distance travel from the community to the nearest health care facilities. Reaching these ‘last mile’ communities can be a daunting task for the formal health systems due to limited number of skilled health staff. For instance, WHO estimates the need of 4.45 doctors, nurses and midwives per 1’000 population as minimum density to achieve universal health coverage and the sustainable development goals. However, the human resource capacity of the operational regions; the Upper East and Northern Regions of the MNCH project is low:
Region / Ratio
Doctor: Population
Nurse: Population
Midwife: Population
Northern Region
1 : 11’130
1 : 479
1 : 854
Upper East Region
1 : 26’489
1 : 340
1 : 611
Overall Ghana
1.06: 10’000
0.93: 1’000
0.93: 1’000
Table 1: Human resource distribution in Ghana Northern Regions (GHS, 2017)
Many pregnant mothers refuse uptake of antenatal care services and facility delivery due to long distance travel from the community to the nearest health care facilities. Reaching these ‘last mile’ communities can be a daunting task for the formal health systems due to limited number of skilled health staff.
To address the increasing realization of
shortages of highly skilled health workers to meet the growing demand of health
services by the rural population, the Ghana Red Cross Society (GRCS), a
volunteer involving organisation, placed greater emphasis on the services of
systematically and professionally trained female volunteers in mothers clubs. These
volunteers are vibrant, respected and trusted women in their communities and
are able to easily reach out to their fellow women and adolescent girls. The Mother
Clubs are the agents through which the GRCS deliver most of their community-based
health interventions.
These volunteers are vibrant, respected and trusted women in their communities and are able to easily reach out to their fellow women and adolescent girls.
Strengthening and supporting the Ghana Health Services
The Mother Clubs are implemented by GRCS with strong collaboration at all levels with the respective structures of the Ghana Health Services (GHS) to complement government’s efforts to improve reproductive health, behaviour change and reduce maternal and new-born deaths in the project communities. The GHS staff at the district and community level provide technical support in the training and supervision of the Mother Club activities. Below is the roles and responsibilities of GRCS and GHS.
The mandate of the Mother Clubs
The MNCH project works with over 3000 self-motivated Mother Club members in over 120 communities in Northern Ghana where maternal and child health records are poor. The activities of the Mother Clubs consist largely of community sensitization and mobilization processes to increase knowledge on MNCH, induce a behaviour change regarding disease prevention and improved access to health service. Specifically, the GRCS Mother Clubs serve as the link between the community and the health care facilities and provide the following responsibilities and tasks with no expectation of any reward or direct charge:
The Mother Club members undertake regular house-to-house visits to provide MNCH related behaviour change messages and supervision services. They undertake health education and sensitisation exercises among community members, especially pregnant women in the various stages of their pregnancy – pre-natal, antenatal and post-natal, and refer them and accompany them to the nearest health provider.
They also organise community meetings (so called “durbars”), interactive theatres and composed health-themed songs (edutainment) for play on local radio stations, community meetings/durbars and other social events. There were instances where the GHS provided them with health messages to compose songs and invited them to perform at launch of new health initiatives.
The Mother Clubs offer also support to the Ghana Health Services health personnel during outreach programme especially child welfare clinics, immunization exercises and all disease control activities. They assist by mobilizing and sensitizing community members and keeping order during outreach services of the community health officers. They also support the local health service, for example they do periodic clean up exercises at the health facilities, they raised funds locally to connect electricity to a health facility, requested for midwives to fill vacant positions in facilities, provided accommodation for midwives; purchased two delivery beds and fixed broken louvre blades at another health care facility.
The MNCH project works with over 3000 self-motivated Mother Club members in over 120 communities in Northern Ghana where maternal and child health records are poor. The activities of the Mother Clubs consist largely of community sensitization and mobilization processes to increase knowledge on MNCH.
Contribution of Mother Clubs to MNCH services delivery
The contributions of MCs have recorded demonstrable achievements. They are nationally recognized for their immerse contribution in health service delivery; reduced and averted morbidity and mortality in mothers, newborns and children. Their sterling performances in community level health service delivery led to stronger linkages between the community and the skilled health workforce, particularly for maternal and child health care. Through their voluntary services, the MCs have contributed extensively to the health and well-being of their communities, in particular to the women and children in the project beneficiary communities. The flexibility and wide network of the MCs allowed a quick mainstreaming of COVID messages into their sensitisation activities to encourage pregnant mothers to continue to attend antenatal care and skilled delivery.
The end-line survey conducted on the MNCH project (End-line survey, Ghana 2020), showed increased adoption of skilled delivery from 69.5% in 2018 (baseline) to 73.8% in 2020 (endline). The percentage of women who had four or more ANC visits, increased from (50.9%) in baseline to (84.4%) in end-line survey. An indication that the work of the MCs complemented the efforts of GHS and contributed to increased deliveries at health care facilities. The project assessment report mentioned Mother Clubs as a driving factor for increased MNCH knowledge, antenatal care visits and skilled delivery (Project Assessment Report, 2020). The report indicated that the MCs support “groups to provide education, resolution and modification of community-based practice, rituals, attitude and behaviour of community members” (Project Assessment Report, 2020).
The flexibility and wide network of the MCs allowed a quick mainstreaming of COVID messages into their sensitisation activities to encourage pregnant mothers to continue to attend antenatal care and skilled delivery.
Furthermore, the Mother Clubs contributed to reduce averse maternal health outcomes. Between 2018 and 2020. they reached out to a total of 8% (1’156 of 14’982) pregnant women, 4% (408 of 12’170) postnatal mothers and 4% (410 of 12’251) newborns with suspected danger signs and referred them to the nearest health facilities for medical care. 92% of the referred cases (suspected danger signs detected) reported to the referral medical facilities for further medical attention, indicating a significant change in health seeking behaviour in the communities through Mothers Clubs efforts.
The performance of the Mother Clubs has been highly commended by Ministry of Health and Ghana Health Services and a host of other development/health partners in Ghana. They are seen as the strong force for promoting positive health knowledge, influence positive attitudes and practices through active community-based health promotion interventions. The positive impact of the project facilitated the acceptance of the project in the community especially by the chiefs and opinion leaders, who welcome their continuity. The approach through the MCs has gained high recognition by Ghana Health Services by the Regional and District Directors who on countless occasions requested for expansion into more districts and communities respectively. The GRCS lobbies at various levels that the Ghana Health Services integrate the Mother Clubs in the general health system, in order to achieve sustainability.
The approach through the MCs has gained high recognition by Ghana Health Services by the Regional and District Directors who on countless occasions requested for expansion into more districts and communities respectively.
Challenges encountered by Mothers’ Club members in delivering their roles and responsibilities
Despite the high impact on MNCH indicators, influence on issues related to behaviour change and uptake of family planning remains low. Sometimes, the MC members report of verbal abuse by some community members, mostly men during their house-to-house sensitisation activities for encouraging their wives to secretly accept family planning without their consent.
There are discrepancies in the management of volunteers by the various volunteer involving organisations in Ghana. As the GRCS go strictly by the volunteering concept, other organisations pay or give stipends to their community health workers on monthly basis. This results into high attrition rate especially among the young female members in the Mothers’ Clubs. Overall, there is high cost of managing the Mother Clubs due to the sheer number. There is high cost of logistics, working tools and supervision costs for the volunteers.
Lessons learned
Project assessment report shows that integration of Mothers Clubs can lead to significant benefits for maternal and child health, increase in immunisation and effective response in health in emergences interventions through social mobilisation and sensitisation activities.
With targeted investments and planning in coordination with health systems strengthening efforts, a network of female volunteer system by the Mothers Clubs is a great enabler to produce strong impacts on maternal and child health. The promotion of health dialogues, the cultural adequate edutainment approach of the Mothers Club members and composition of MNCH related and other health songs facilitated the delivery of positive MNCH messages and empowered community members with the knowledge of adequate health information.
MNCH Project End-line Survey Report – Maternal Newborn and Child Health Project 2018-2020, Ghana. February 2021.
MNCH Project Internal Assessment - Report of interviews – Ghana April 2021
WHO (2016), Health Workforce Requirements for Universal Health Coverage and the Sustainable Development Goals. Human Resources for Health Observer Series No 17. https://apps.who.int/iris/handle/10665/250330
KeviEvans works
as Project Advisor for the Swiss Red Cross supported RMNCAH Project in Ghana. He
has a background in Community Health and Development and Adult Education with
experience in Community Engagement and Accountability approaches. He oversees
the development, implementation and management of the RMNCAH Project, provide
technical assistance, direction, operational and strategic support to the Ghana
Red Cross Society in the implementation of the project. Email
