Spatial patterns of delivery service utilisation: using a spatial interaction model approach to reach every woman in Eastern Region, Ghana.

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Interventions for reducing the maternal mortality ratio to less than 70 per 100 000 live births by 2030 require information to improve service quality, bridge access and utilisation gaps, and adequately plan maternal health services. This study would be of immense benefit to health service delivery not only in Ghana, but in other countries with similar healthcare information as well as being of academic interest. It would provide the health service with information that might change previous perceptions of utilisation patterns, thereby enhancing plans to reduce maternal deaths. For instance, understanding the interaction between healthcare quality and utilisation would enable targeted improvement in quality care, hence saving costs associated with wholesale implementation of interventions. The output of this study would inform a fair distribution of skilled delivery services to reach every woman, thereby averting maternal deaths.Utilisation patterns among hospitals have been explored in the MSc work but primary lower level health facilities contribute more than one third of total births in the region. Hence further analysis of data would reveal the effect of primary health facilities on the overall utilisation patterns. The MSc report revealed a high influx of clients from the periphery of Greater Accra region closer to Nsawam hospital. Advanced Bayesian statistical models would be implemented to predict utilisation of delivery services in the Eastern region. This approach would provide a framework for estimation of utilisation patterns.ObjectivesThe goal of this study is to use spatial interaction modelling approach to understand utilisation of delivery services. This goal would be achieved through analysis of data to achieve the following objectives:1. To formulate a Bayesian model that estimates the probability of utilisation of delivery services.2. To estimate the quality of maternal health care delivery in health facilities.3. To delineate realistic catchments for delivery services based on observed flows.4. To quantify the bypassing of skilled delivery facilities and determine individual factors that promote it.MethodsData sourcesThe following sources would be consulted for data to meet the set objectives:1. With the support of Dr. Quansah, Ghana health service would be contacted for routine delivery records2. Health facilities would be surveyed to create quality of care indices3. Gridded surfaces of pregnancy counts would be modelled in collaboration with WorldPop.4. Women who have interacted with delivery services would be interviewed to determine individual limitations to accessing care and calibrate drive times based on type of transportation.