Assessing the Equitable Distribution of Essential Medicines for Rural Maternal and Child Health Care: Baseline Report, Nkwanta District, Ghana

This 4-page report documents the background and progress of the Ghana Essential Medicines Initiative (GEMI), which aims to provide essential drugs to rural areas as well as training and information on maternal and child health. The project also aims to find sustainable policy solutions for the provision of essential medicines in Ghana. According to the report, GEMI helps to support the work of the Community-based Health Planning and Services project (CHPS), which posts nurses to rural areas to provide basic curative and preventative care.

The report mentions that in rural Africa, a high demand for fertility often exists as part of a traditional pronatalist society. Since CHPS nurses work within the confines of these cultural beliefs, they are compelled to provide family planning to women on an anonymous basis in a closed and confidential environment. Female clients trust their health-care worker to arrange appointments in convenient places: at their homes, in the marketplace, after church, or even by the riverside where they are doing their daily chores.

The report states that according to the most recent Demographic and Health Survey data collected for 31 countries in sub-Saharan Africa, Ghana has the highest unmet need for family planning in all of West Africa. In areas such as Nkwanta District, which have extremely low levels of female education and predominantly consist of remote villages with indigenous populations, substantial support and assistance in providing family planning to women will be required if the situation is to improve.

According to the report, research from GEMI's tracking and monitoring of drug inventories and district facilities has found that although CHPS has better performance quality than other facilities, the number of drugs available are limited. It also found that nurses do not recover costs for door-to-door services, which greatly reduces their revenue potential to purchase more drugs. The main reasons for drug stockouts at district facilities include: providers did not request drugs or were unaware of shortages; stockouts at the district level; and either low or high demand and usage.

Based on these findings, the authors provide a number of recommendations for district facilities. These include designing a local group insurance system for CHPS zones to allow for greater recovery of costs and purchase of additional medicines; development of a GEMI in-service training curriculum for the proper supply, handling, storage, and prescription of essential medicines; increasing the diversity of family planning methods, including emergency contraception; and including new mothers in community health talks to create awareness of prevention, symptoms, and appropriate services needed for common childhood diseases.