Keele Research Repository

Despite evidence of widening geographical inequalities in maternal and child health (MCH) coverage and outcomes between the Upper West region (UWR) in the north and the Ashanti region (AR) and Greater Accra region (GAR) in southern Ghana, the relative importance of the underlying social determinants remains unexplored. Policy to reduce MCH inequalities is therefore missing important checks on likely effectiveness. One possibility explored in this thesis based on evidence from national MCH surveys and qualitative studies is that differential access to skilled MCH Providers is an important explanation and a matter for policy attention. Using convergent mixed methods research design, this study assessed whether in Ghana‘s context specifically, increased geographical access to life-course high-impact MCH interventions by primary health care level skilled MCH Providers might contribute more significantly and more immediately to reduction in maternal and neonatal mortality inequalities. Thus, policies to improve, for example, education, income and occupation seen as appropriate measures in other national contexts contribute less. Studies elsewhere support this thesis: maternal and neonatal mortalities responded best to increases in availability of trained service providers. The study throws light on how informed investment in innovative, local-context HRH policy interventions in MCH resource-poor and rural locations could reduce Ghana‘s geographical health inequalities. The findings suggest narrowing neonatal and institutional maternal mortality inequalities more in response to increased geographical accessibility, utilization and coverage of skilled MCH Provider services in UWR than mother‘s education, income and occupation. UWR‘s own recent skilled MCH Providers attraction and retention interventions; and decentralized integrated midwifery/nursing training national policy narrowed the perennial doctor and midwife density gaps between UWR and the AR and GAR. Thus, with evidence-based accelerated state investment in properly decentralized HRH functions and budget, infrastructure and social amenities in UWR (and sister unattractive regions), universal health coverage and sustainable MCH inequalities reduction appear attainable in Ghana.