The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study
Abstract Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver e...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-021-07141-5 |
| _version_ | 1818724711070171136 |
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| author | Onikepe Owolabi Taylor Riley Easmon Otupiri Chelsea B. Polis Roderick Larsen-Reindorf |
| author_facet | Onikepe Owolabi Taylor Riley Easmon Otupiri Chelsea B. Polis Roderick Larsen-Reindorf |
| author_sort | Onikepe Owolabi |
| collection | DOAJ |
| description | Abstract Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. Methods We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. Results Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. Discussion Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. Conclusions SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care. |
| first_indexed | 2024-12-17T21:30:45Z |
| format | Article |
| id | doaj.art-515a96293f2e44089f7e1662e80c06fe |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-17T21:30:45Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-515a96293f2e44089f7e1662e80c06fe2022-12-21T21:31:53ZengBMCBMC Health Services Research1472-69632021-10-0121111010.1186/s12913-021-07141-5The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional studyOnikepe Owolabi0Taylor Riley1Easmon Otupiri2Chelsea B. Polis3Roderick Larsen-Reindorf4Guttmacher Institute, 125 Maiden LaneGuttmacher Institute, 125 Maiden LaneDepartment of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and TechnologyGuttmacher Institute, 125 Maiden LaneDepartment of Obstetrics & Gynaecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and TechnologyAbstract Background Ghana is one of few countries in sub-Saharan Africa with relatively liberal abortion laws, but little is known about the availability and quality of abortion services nationally. The aim of this study was to describe the availability and capacity of health facilities to deliver essential PAC and SAC services in Ghana. Methods We utilized data from a nationally representative survey of Ghanaian health facilities capable of providing post-abortion care (PAC) and/or safe abortion care (SAC) (n = 539). We included 326 facilities that reported providing PAC (57%) or SAC (19%) in the preceding year. We utilized a signal functions approach to evaluate the infrastructural capacity of facilities to provide high quality basic and comprehensive care. We conducted descriptive analysis to estimate the proportion of primary and referral facilities with capacity to provide SAC and PAC and the proportion of SAC and PAC that took place in facilities with greater capacity, and fractional regression to explore factors associated with higher structural capacity for provision. Results Less than 20% of PAC and/or SAC providing facilities met all signal function criteria for basic or comprehensive PAC or for comprehensive SAC. Higher PAC caseloads and staff trained in vacuum aspiration was associated with higher capacity to provide PAC in primary and referral facilities, and private/faith-based ownership and rural location was associated with higher capacity to provide PAC in referral facilities. Primary facilities with a rural location were associated with lower basic SAC capacity. Discussion Overall very few public facilities have the infrastructural capacity to deliver all the signal functions for comprehensive abortion care in Ghana. There is potential to scale-up the delivery of safe abortion care by facilitating service provision all health facilities currently providing postabortion care. Conclusions SAC provision is much lower than PAC provision overall, yet there are persistent gaps in capacity to deliver basic PAC at primary facilities. These results highlight a need for the Ghana Ministry of Health to improve the infrastructural capability of health facilities to provide comprehensive abortion care.https://doi.org/10.1186/s12913-021-07141-5GhanaAbortionPost-abortion careSafe abortion careQuality of careInfrastructural quality |
| spellingShingle | Onikepe Owolabi Taylor Riley Easmon Otupiri Chelsea B. Polis Roderick Larsen-Reindorf The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study BMC Health Services Research Ghana Abortion Post-abortion care Safe abortion care Quality of care Infrastructural quality |
| title | The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study |
| title_full | The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study |
| title_fullStr | The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study |
| title_full_unstemmed | The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study |
| title_short | The infrastructural capacity of Ghanaian health facilities to provide safe abortion and post-abortion care: a cross-sectional study |
| title_sort | infrastructural capacity of ghanaian health facilities to provide safe abortion and post abortion care a cross sectional study |
| topic | Ghana Abortion Post-abortion care Safe abortion care Quality of care Infrastructural quality |
| url | https://doi.org/10.1186/s12913-021-07141-5 |
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