Project News

The fourth Joint Coordination Committee (JCC) meeting was held on 9th June 2021 in Accra, Ghana. This meeting brought 34 participants from the Ministry of Health (MOH), Ghana Health Service (GHS) headquarter, Regional Health Directorate, WHO, UNICEF and JICA Ghana office. While the JCC meeting is usually to be taken place every six months, this JCC meeting was postponed for about a year due to COVID-19 outbreak and this was the first meeting since the last meeting conducted in December 2019. The main agenda of the fourth JCC meeting was to wrap up and evaluate the progress of the Project from January 2020 to June 2021 and to discuss the planned activities by the project end and future directions of the Maternal and Child Health Record Book (MCH RB) Program after the completion of the Project.

Remarks from the representatives

Dr. Patrick Aboagye, Project Director, Director General of GHS, expressed gratitude to the support of JICA and the MCH RB team to introduce the MCH RB in Ghana and made substantial achievements with the MCH RB, and created the value attached to the book. He continued that sustainability remains a challenge here, but the utilization of the book needs to be ensured to achieve our goals, which is to save lives and promote the wellbeing of all mothers and children utilizing the MCH RB.

Dr. Ernest Asiedu, Head, Quality Management Unit, Ministry of Health (MOH), remarked that MCH remains a priority to the Ministry as its core in the Ghana Universal Health Coverage (UHC) Road Map. He stated that the MOH is committed to provide quality MCH services to all mothers and children with the effective use of the MCH RB. He also pointed out three core issues of MCH RB; 1) MCH RB's role in QOC is obvious if the book was effectively used for early detection and early treatment, 2) significance of resource mobilization to sustain the program, and 3) MOH should take responsibility to sustain the program and to maintain standard use of the book at the agencies under MOH by providing necessary support to those agencies.

Ms. Ozawa Maki, Senior Representative of JICA Ghana Office, expressed her appreciation for the leadership and commitment of the GHS HQ and Ashanti Region for the smooth operation of the project and remarkable achievement. She remarked that JICA was content, first of all, that the project activities were sustained, and Ghana succeeded in providing essential MNCH and Nutrition services under the COVID-19 and she remarked on the GHS and Partner's efforts. She was also happy to see the active participation of the stakeholders in this meeting and active discussion has already taken place for the sustainability of the MCH RB program. She wished the JCC meeting to be further fruitful to discuss ways forward as the MCH RB project to be terminated in January 2022.

Ms. Ozawa remarked at the 4th JCC meeting.

Dr. Hagiwara responded some of the questions and comments.

Overall progress of the project

After the opening remarks, Ms. Esi Amoaful, Deputy Director, Nutrition, Family Health Division (FHD), GHS, presented the overall progress of the project highlighting major activities conducted and milestones achieved. This project has three main pillars: national rollout of the MCH RB, intensive capacity development in Ashanti Region and the institutionalization of MCH RB. Regarding the national rollout, a pretest of the eight scripts for the audio-visual learning material took place in March 2020. All the training materials were reviewed and finalized; such as trainers' guide, participants' manual, user guide and flip chart. Also, the project continues the health worker trainings in some regions and the second National Monitoring and Supervision is on-going. As for the activities in Ashanti region, the 1st and 2nd Monitoring and Supervision were conducted in 11 focus districts. Also, a technical workshop for the development of plan of SBCC strategy and implementation was hold in April 2021. Furthermore, in terms of institutionalization of MCHRB, the second workshop for the development of management guide was held in January 2021.

Reports of the National and 11 districts Monitoring and Supervision

Ms. Veronica Quartey, Nutrition Officer, GHS HQ and Ms. Olivia Timpo, Regional Nutrition Officer. Ashanti Regional Health Directorate made a presentation on the mid-term report of the 2nd National M&S and the 1st and 2nd M&S in 11 districts in Ashanti region. The new service of length measurement started nationwide and the length board became available at more than 80% of health facilities in the nation. Nutrition counseling which is also newly introduced service with MCH RB started at least 50% of health facilities nationwide, more than 80% in 11 districts, while the filling rate of the counseling table remains low. Ms. Quartey emphasized the importance of early detection in recording MCH RB as health workers try to fill the MCH RB fully but sometime don't take action for early treatment and/or referral.

Plan of activities for January 2020 to March 2021

Dr. Akiko Hagiwara, Chief Advisor, Ghana MCHRB Project, presented the proposed plan of activities for January 2020 to March 2021. Regarding the national roll-put, the project will continue the 2nd National M&S and hold a MCH RB review meeting to share the results, good practices and lesson learnt. Also, the shooting of Visual Aid Material starts soon, and the final products will be shared with all concerned people. As for the activities in Ashanti region, the third M&S is on-going and the validation workshop for the Operational Gude of Nutrition Counseling Services and Respectful Care will take place after the completion of the M&S. Moreover, the end-line survey will be conducted in August-September to see the impact of project interventions. In term of initialization, the Management Guide will be finalized after a series of discussions and a Project dissemination workshop will take place to share the experience of national rollout and the overall achievements.

Discussion on sustainability

Continuing from the third JCC meeting, the sustainability of MCH RB program is one of the most important discussion points at this meeting. Currently, we see some challenges; for example, due to the shortage of the MCH RB, the books were printed and sold at facilities, but the quality didn't meet the basic specification and the cost was unreasonably high. A solid MCH RB management system should be established to solve these problems and maintain the MCH RB program, and the financial sustainability, the technical sustainability and the management and coordination of the program should be secured in the system.

In terms of the financial sustainability, one participant proposed that the resources for the printing should be collected to the GHS HQ and the MCH RB should be printed at the central level for saving the printing cost as well as to protect the standard of the MCH RB. Also, it was commented that we should explore the feasibility of charging a minimum amount to all mothers to receive MCH RB.

Regarding the technical sustainability, it was suggested that while the training at preservice institutions and the orientation to the new staff were important, the most effective approach for capacity building might be the supervision and coaching at each facility level, where the supervisors in charge monitor and coach health workers in daily routine. Dr. Hagiwara added that the Audiovisual learning materials on the skills needed for effective utilization of the MCH RB will be produced for self-learning or the group orientation and thus the materials should be widely distributed on the GHS website.

As for the management of the MCH RB program, a participant commented about the importance of procurement management based upon the forecasting and clear monitoring of the distribution. At central and regional stores, Ghana Integrated Logistics Management Information system software (GhiLMIS) will be helpful to monitor stock and distribution. Participants all agreed upon the importance of quality control in the production of MCH RB and the necessity of the management guide which states the rules and regulations related to the application and approval process of the reproduction of the MCH RB by stakeholders.

Group Photo of the participants at the 4th JCC meeting

Way forwards

This is the final year of the project implementation. The project continues the monitoring and supervision at 11 districts as well as nation wide so that all trained health workers will be able to provide quality services with gained skills and knowledge. The project is going to finalize the management guide and the operational guide on NCSRC and to share all the good practices and lesson leant with all the concerned people. The project and the counterparts are going to continue working together to achieve the project objectives.