Project News

The project started the second National Monitoring and Supervision (M&S) on 22nd February 2021. This was the second M&S following the first one conducted in 2019, which was supposed to be conducted in 2020 but postponed due to the Covid-19 pandemic.(See the project news ‘The first Monitoring and Supervision in 10 regions'.)

Before starting the M&S, the technical team reconfirmed the modality of the M&S and reviewed the M&S checklist which was used to assess the logistic management, health workers' skills and knowledge and pregnant women's/mother's experience. The monitoring team consists of National facilitators, Regional facilitators, District facilitators and staff of the MCH RB Project. In each region, the monitoring team visits the Regional Health Directorate (RHD), three District Health Directorates (DHDs) and an average of nine health facilities within one week, which is the same modality as the first M&S. Since additional training sessions have been conducted by the project as well as the other partners such as World Bank, which introduced and strengthened Nutrition Counseling Services with MCH RB, some checkpoints were added into the checklist; for example, whether the flow of ANC/CWC was modified to effectively conduct the nutrition counseling and whether the designated area for counseling to protect client's privacy was located at the facility. Moreover, in order to see the adaptation to and the influence of Covid-19 on the service delivery and uptake, the checklist included questions on the reorganization of the modality of the services delivery at facilities and the changes in the number of ANC/CWC visits under COVID-19.

The M&S started in Greater Accra (GA) Region and Northern Region. The GA team visited three districts located on the east side: Ningo Prampram, Ada East and Shai Osu-Doku. The growth chart and nutrition counseling table were not recorded appropriately 2 years ago when the first National M&S was conducted. The monitoring team found a certain number of MCH RB in which the growth charts were correctly plotted, and the nutrition counseling table were properly filled at this time. Length/ height measurement and Nutrition Counseling were the services newly introduced with this combined MCH RB and health workers started to use newly acquired skills into the quality services.

Checking the tally card on MCH RB at the district hospital

Assessing a counseling at ANC at a health center in Shai Osu-Doku district

CWC at a CHPS in Ningo Prampram district

Assessing the skill of length measurement at a health center in Shai Osu-Doku district

At the facilities, health workers respected well the guidelines for the provision of essential MCH and Nutrition services under the COVID-19 outbreak. They guided clients to wear masks and wash their hands. Also, they provided Child Welfare Clinic (CWC) not on the particular day of the week but every day to avoid the crowd of clients. Consequently, a mother said, ‘I'm coming here for CWC as scheduled because I feel that I am protecting myself with the face mask and health staff also protecting themselves.'

On the other hand, some challenges were identified. In Ghana, all pregnant women are encouraged to come to the ANC before the 12th week of their pregnancy so that the solid examination can be conducted at the early stage of pregnancy. The weight gain during pregnancy is one of the points to check. It is necessary to calculate a pregnant woman's Body Mass Index (BMI) before the 12th week of the pregnancy to estimate the desired weight at the expected delivery date and provide nutrition counseling based on the results. Unfortunately, many pregnant women come to ANC after the 12th week, which makes it difficult for health workers to provide services at the appropriate time. This is a missed opportunity for better health services and health outcomes. Another missed opportunity was that the page of developmental milestones in which health workers and mothers can assess the development of their children together has not been fully utilized. These points identified by the monitoring team on site were shared with and will be followed up by District and Regional facilitators.

In this quarter, the monitoring team plans to visit six regions: Greater Accra Region, Northern Region, Central Region, Oti Region, Eastern Region and Ahafo Region. The team will visit the remaining regions in the next quarter. The monitoring is a good opportunity to solve problems, share updated information, improve capacities of health workers with on-site coaching and document good practices of the effective utilization of the MCH RB. The project is committed to continuing effective M&S.