Quality along the Continuum: A Health Facility Assessment of Intrapartum and Postnatal Care in Ghana

Objective: To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate “effective coverage ” of skilled attendance in Brong Ahafo, Ghana. Methods: We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC), emergency newborn care (EmNC) and non-medical quality. Linking the health facility assessment to surveillance data we estimated “effective coverage ” of skilled attendance as the proportion of births in facilities of high quality. Findings: Delivery care was offered in 64/86 facilities; only 3-13 % fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63 % and 58 % of facilitie