Research Project (Ongoing)

Impact Evaluation of the Maternal and Child Health Handbook in the Republic of Ghana

In the Republic of Ghana, various efforts have enhanced access to and the quality of health services over the past 30 years such as the introduction of a national health insurance scheme, an increase in the number of doctors and nurses, the expansion of community health services, and improvements of infrastructure and equipment. As a result, the maternal mortality ratio declined from 943 to 234 per 100,000 live births between 1985 and 2023, and the under-five mortality rate fell from 128 to 40 per 1,000 live births between 1990 and 2022. However, despite these improvements in maternal and child health indicators, Ghana has yet to achieve the Sustainable Development Goals (SDGs) in this area. In particular, rural areas with high poverty rates continue to see limited access to skilled birth attendants, resulting in persistently higher maternal and child mortality rates compared to urban areas.

Based on the findings of the EMBRACE (Ensure Mothers and Babies’ Regular Access to Care) implementation research project conducted from 2012 to 2016 by the Government of Ghana, the University of Tokyo, and JICA, the Government of Ghana decided to promote a continuum of care for mothers and children by developing an integrated Maternal and Child Health (MCH) Handbook that combines mother’s health records, child health records, and a Continuum of Care (CoC) card with the essential health education messages. JICA has provided technical and financial support for the development of the handbook since 2016, culminating in the completion of a nationally scalable version in March 2018.

From April 2018 to January 2022, JICA implemented the "Project for Improving Continuum of Care for Mothers and Children through the MCH Handbook" in Ghana and supported the nationwide rollout and institutionalization of the MCH Handbook. Training and monitoring activities were conducted in all 16 regions of the country. A 2021 survey confirmed that the MCH Handbook was being used in public, private, and NGO health facilities nationwide, contributing to the increased birth registration, improved communication, and the provision of respectful care. However, the impact of continuous use of the handbook from pregnancy (fetal period) through early childhood has not yet been evaluated. Additionally, there is a need to analyze and assess the factors that have facilitated or hindered the implementation and institutionalization of the MCH Handbook Program, which is now funded and sustained by the Government of Ghana.

This study aims to verify the effects of the nationwide rollout of the MCH Handbook on maternal and child health indicators by utilizing secondary data sources such as the Demographic Health Survey (DHS). It will also assess whether continuous use of the handbook from pregnancy to infancy contributes to improved service coverage, healthcare practice at home and child weight gain through field observations and interviews. In addition, the study will analyze facilitators and barriers to nationwide implementation from the perspectives of implementation science and health systems, with the goal of further strengthening the MCH Handbook Program in Ghana and providing insights into future support initiatives involving these handbooks.

JICA, in collaboration with WHO and UNICEF, has developed an implementation guide for home-based health records, identifying key success factors for nationwide expansion. The findings from this study are expected to contribute valuable insights for that guide.

Chief Researchers:
Hagiwara Akiko, JICA Senior Advisor on Health
Samuel Kaba Akoriyae, Director-General, Ghana Health Service

Co-researchers:
Shibanuma Akira, Tokyo University
Abraham Rexford Oduro, Ghana Health Service
Keneddy Tettey Coffie Brightson, Ghana Health Service
Olivia Mawunyo Timpo, Ghana Health Service
Gifty Ampah, Ghana Health Service
Joshua Billy, Ghana Health Service
Makimoto Saeda, JICA
Omachi Mayumi, JICA
Hatano Natsuko, JICA
Kajino Mayuna, JICA