title: Upgrading obstetric care at the health center level, Juaben, Ghana. The Kumasi PMM Team.
abstract: BACKGROUND
  Inventory and observations at Juaben Teaching Health Center (JTHC) revealed an inability to treat obstetric complications. Women with complications needed to be referred to other institutions, resulting in delays.
  
  
  METHODS
  During 1993 and 1994, an operating theater and blood bank were established and equipped, the maternity refurbished, and a revolving drug fund created. A physician was posted and trained in obstetrics, and midwives were trained in life-saving skills. A running water supply was established. Subsequent community interventions focused on improving access and reducing the delay in seeking care.
  
  
  RESULTS
  The number of women with complications coming for care increased almost three-fold, from 26 in 1993 to 73 in 1995 and the proportion of these who were referred for treatment dropped from 42 to 14%. Surgical obstetric procedures performed at JTHC increased from 23 in 1993 to 90 in 1995. Midwives performed 32% of manual removals, 58% of vacuum extractions and 98% of episiotomy repairs. No deaths occurred among the women treated.
  
  
  RESULTS
  The cost of improvements was approximately US $30,000, mostly for equipment and supplies. Forty percent came from project funds, 36% from non-governmental organizations (NGOs), 15% from government and 9% from community members. The salary of the new physician cost an additional $4700 annually.
  
  
  CONCLUSIONS
  Modest improvements can increase the provision and utilization of emergency obstetric care. Collaboration with NGOs, government and the community can be beneficial.
authors.affiliation: School of Medical Sciences, Ministry of Health, Kumasi, Ghana.
authors.forename: J O
authors.initials: JO
authors.lastname: Djan
authors.forename: S
authors.initials: S
authors.lastname: Kyei-Faried
authors.forename: S
authors.initials: S
authors.lastname: Twum
authors.forename: J B
authors.initials: JB
authors.lastname: Danquah
authors.forename: M
authors.initials: M
authors.lastname: Ofori
authors.forename: E N
authors.initials: EN
authors.lastname: Browne
mesh_terms: D003151:Community Health Centers; D019058:Community Networks; D005260:Female; D005869:Ghana; D006801:Humans; D008427:Maternal Health Services / Q000191:economics / Q000592:standards; D008428:Maternal Mortality; D011247:Pregnancy; D015397:Program Evaluation; D011787:Quality of Health Care / Q000191:economics