In 2013, Felix Dabuo, Bertinus Dery and Mavis Ibkang became some of the first REAL Award winners.

This trio of nurses is known for their commitment, creativity, and local leadership that have inspired all people within their region of Ghana. They perform their jobs admirably in spite of the many challenges they encounter in the rural, poor and sparsely populated parts of the Upper West Region of Ghana. While they perform their duties on a daily bases to the admiration of many, there is one story in particular that comes to mind.

It all started when Stella Wullobong started getting labour pains at 4am one morning in 2009. Although it was raining heavily at the time, Stella, age 35, knew she could not deliver the baby at home. She and her husband struggled through the rain to the Somboro health compound, only to meet an empty facility – Bertinus and Felix were in the middle of home visits. Bertinus and Felix received a phone call from Stella’s husband, informing them his wife was in labour. “Upon receiving the message,” Felix explains, “we immediately rushed to attend to our client.” Despite the heavy rain and extremely poor road conditions, Bertinus and Felix knew that they should not attempt to deliver the baby because of Stella’s history of multiple deliveries; this was her twelfth pregnancy. ”The usually waterlogged and impassable untarred road from Somboro to Sabuli was worse than usual. “We started on our journey,” Stella recalls, “but the road was full of water. So we struggled.”

Fortunately for them, people from the community met them at the river to help them get across. They carried Stella and the motorbike while wading across the bridge. Soon thereafter they developed a flat tyre. Bertinus had to call Felix and ask him to bring the other motorbike, because the weather made it impossible to repair the flat tire. “Thanks to our District Director, who provided us with two motorbikes,” Bertinus said. “Otherwise, we would have sunk deep into trouble.” Bertinus and Stella persevered, and finally managed to arrive at the health centre. On arrival, they had another surprise – the midwife was absent. All that effort – and no midwife or doctor! By this time, Stella had entered the second stage of labour. The only person at Sabuli Health Centre when they arrived was Mavis Ibkang, a Community Health Nurse. The team decided to proceed with the delivery, as it was too late to call an ambulance from the hospital. They were able deliver a bouncing baby boy safely without complications. “I knew I was at high risk of complications in any subsequent deliveries,” Stella said. “I was well aware of this because I received antenatal care from Felix and Bertinus, who also educated me that I must come to the compound at the first signs of labour.” This knowledge saved her life and the life of her baby.

Neonatal mortality rate  (per 1,000 live births) (2011) 29
Under-five mortality rate (per 1,000 live births) (2011) 78
Maternal mortality ratio (per 100,000 live births) (2010) 350
Number of doctors, nurses and midwives per 10,000 people (2010) 11.3
Births attended by skilled personnel (2008) 54.7%
Total expenditure on health as a percentage of gross domestic product (2011) 4.8%
General government expenditure on health as a percentage of total expenditure on health (2011) 56.1%

In Ghana, approximately 61% of the population is covered by the National Health Insurance Scheme, a package of care that provides services for the majority of health problems, with a particular focus on maternal and child health. Premiums are determined by income level, with exemptions for vulnerable groups. Maternal outcomes are improving, but much remains to be done to improve child health.

Although there is a dedicated Human Resources Division of the Health Service, and steps have been taken to involve other key stakeholders in policy development, there is evidence that sustained efforts will be required to fully address workforce challenges. The availability of skilled health professionals is below indicative thresholds, and with rapid population growth, it may be unlikely to scale up effectively before 2035. The density of physicians is particularly low and features significant disparities in geographic distribution. There is need for a greater emphasis on strengthening regulatory mechanisms to improve quality. Also data collection systems require improvement to inform effective policy. However, positive measures have been taken to improve remuneration, and there has been a decline in migration outflows of health workers, especially nurses.

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