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Background Achieving the Millennium Development Goal (MDG) of improving maternal health has become a focus in recent times for the majority of countries in sub-Saharan Africa. Ghana's maternal mortality is still high indicating that there are challenges in the provision of quality maternal health care at the facility level. This study examined the implementation challenges of maternal health care services in the Tamale Metropolis of Ghana. Methods Purposive sampling was used to select study participants and qualitative strategies, including in-depth interviews, focus group discussions and review of documents employed for data collection. The study participants included midwives (24) and health managers (4) at the facility level. Results The study revealed inadequate in-service training, limited knowledge of health policies by midwives, increased workload, risks of infection, low motivation, inadequate labour wards, problems with transportation, and difficulties in following the procurement act, among others as some of the challenges confronting the successful implementation of the MDGs targeting maternal and child health in the Tamale Metropolis. Conclusions Implementation of maternal health interventions should take into consideration the environment or the context under which the interventions are implemented by health care providers to ensure they are successful. The study recommends involving midwives in the health policy development process to secure their support and commitment towards successful implementation of maternal health interventions. [ABSTRACT FROM AUTHOR]

Objective In the absence of an adequate vital registration system in Ghana, the Navrongo demographic surveillance system (NDSS) established in 1993 presents a viable alternative to monitor, in a poor rural district, the UN Millennium Development Goal on maternal health (MDG) of reducing maternal mortality by 75% between 1990 and 2015. Methods Of the 518 women aged 12–49 years identified in the NDSS database to have died in the Kassena-Nankana district in the period January 2002–December 2004, spouses or family members completed verbal autopsy interviews for 516 female deaths. Results Of the 516 female deaths, 45 were identified as maternal deaths. 71% of the maternal deaths were attributed to direct maternal causes while 29% were due to indirect maternal causes. Abortion-related deaths were the most frequent cause of maternal deaths. The maternal mortality ratio for the period 2002–2004 was 373 maternal deaths per 100,000 live births indicating a 40% reduction of maternal mortality from the 1995–1996 level of 637 maternal deaths per 100,000 live births. However, the health-facility based maternal mortality ratio in the district (which excludes maternal deaths outside health facilities) was 141 maternal deaths per 100,000 live births for the period 2002–2004. Conclusion This district may be on track to achieve the MDG on maternal health. Ultimately, strengthening vital registration systems to provide timely information to policymakers should supersede the other methods of measuring maternal mortality. [ABSTRACT FROM AUTHOR]

High-level political support for the United Nations Millennium Development Goals (MDGs) drew international attention to included causes at the turn of the century. Influences of this normative framework on national-level health agenda setting remain little investigated. This study investigates the agenda status of maternal survival against the backdrop of the MDGs in two countries in sub-Saharan Africa. Informed by replicative case studies conducted in Ghana and Tanzania, the study finds the MDGs played a significant role in the issue's increasing status in both countries by helping to align several factors that facilitate the agenda setting process, including: ideas concerning the severity of the problem and expectations for its redress; institutions that shape policies, programs and monitoring; and economic and political interests. The agenda setting process was similar in the countries but for two dynamics. HIV/AIDS dominated Tanzania's health policy agenda in the early 2000s, crowding out attention to maternal and other health issues. A network of concerned actors that expanded to form a broad political coalition later facilitated agenda setting in Tanzania, including securing some budgetary commitments. By contrast, Ghana's core maternal health network remained technically oriented and closed to broader political and civil society engagement, limiting its capacity to expand issue attention and budgetary commitments beyond the health sector., (Copyright © 2019 Elsevier Ltd. All rights reserved.)