The Ministry of Health and the Ghana Health Service have developed the Integrated "Maternal and Child Health Record Book" with technical and financial support from Japan International Cooperation Agency (JICA). The work to develop the book started in early 2016 followed by a pretest of the draft book, and a pilot test was carried out in three regions (Upper West, Ashanti and Central) in 2017 to assess the effective utilization of the book in all the different service delivery points. The book was launched for national distribution on March 2018.
All pregnant women can receive a Maternal and Child Health Handbook, which is called MCH Record Book in Ghana, for free at health facilities when her pregnancy is confirmed. One book covers one pregnancy and one child.
Understanding and acceptance of the MCH Handbook are high among mothers and family members. In the development process of the MCH Handbook in Ghana, a pretest of the draft book was conducted to identify the level of understanding, socio-cultural acceptance, attractiveness, compliance/motivation for behavioural changes among mothers, fathers and grandparents. The draft book was modified according to the results of the pretest; as a result, health and nutrition messages are provided with many illustrations so that all women can easily understand them.
All the pregnant women (around 1 million out of 1 million) received MCH Record Book in 2021 in Ghana.
Cost indicators:
- A MCH Record book costs around US$1 in Ghana.
- Development partners have been supporting the printing of the MCH Record Book.
- The government of Ghana gradually takes responsibility for securing the budget for the printing of the MCH RB for sustainability.
- In 2021, the National Health Insurance Authority (NHIA) printed 50% of MCH RB (500,000), which is the Government Budget.
- In 2022, National Health Insurance Authority and Birth and Deaths Registry printed 2,500,000 copies and 1,000,000 copies of MCH Record Book were printed by in 2023.
- The Birth and Deaths Registry printed 1,200,000 copies of MCH Record Book in 2024.
Multi-level governance involving Ghana Health Service Headquarter (Guidance, Budget, Monitoring and supervision), Regional/District Health Directorate (Training, Monitoring and supervision) and Health facilities (Utilization/Implementation)
Monitoring and Supervision Checklist is available to check the effective use of MCH Record Book for counseling skills.
In monitoring the implementation of the MCH Record Book, three categories of monitoring are carried out:
- Program specific Monitoring and Supportive Supervision (M&S) at all levels
- Integrated Monitoring and Supervision
- On-the-job monitoring and coaching.
Ghana Maternal and Child Health Record Book Project - A pilot test was conducted from June 2017 till February 2018 at 15 selected health facilities in six districts in three regions (Upper West, Ashanti and Central) to test if there are comparative advantages of MCH Record book to on-going maternal health records and child health records and to test if the books are utilized effectively for all different service delivery points at all stages of care (ANC, delivery, PNC, CWC). The main finding of the study is that CoC completion rate among intervention group was higher than in control (Intervention 76%, Control 63%).
The first Monitoring and Supervision Maternal and Child Health Record Book national roll-out - Out of 95 facilities visited, 82% were using Maternal and Child Health Record Book (MCHRB). Out of 34 districts visited, 25 districts (73%) conducted trainings for all facilities in the district. While 91% of MW at CHPS level were trained, only 61% of MWs at the hospitals had received training.
Baseline/Endline Surveys and Situation Analysis for the Intervention of MCHRB Project in Ashanti Region and Results of Baseline Surveys and Situation Analysis for the Intervention of MCHRB Project in Ashanti Region - Utilization of the MCH RB in both intervention and control districts is generally low; especially records on BMI, estimated desired weight range at EDD, plotting on length-for age chart, nutrition tables, ECD checked (less than 20%). More than 75% of pregnant women are meeting the MDD (5+ Food Groups) and MMF (3+). More than 70% of children are meeting the MDD (4+ Food Groups) and MMF (3+), and consuming animal source food. Most health workers are satisfied with the MCH and Nutritional services they are providing.
Pilot test for using MCH Record Book in GHANA - Mothers with MCH RB increased knowledge on danger signs during pregnancy and child care, how to prepare for delivery, date of next visit, and the duration of exclusive breast feeding more than the control group. More couples with MCH RB discuss danger signs of a child (Intervention 84%, control 64%, p<.001) ,“discussed delivery plan” (intervention 83.6%, control 64.3%, p<.001), prepared for delivery (intervention 83.6%, control 64.3%, p<.01). 86% Health workers who used MCH RB evaluated that the new combined MCH RB makes their work more efficient than old separate record books.
The Maternal and Child Health (MCH) Handbook and its Influence on Health Behaviors: A Literature Review - MCH handbook is an effective tool that positively influences the behaviours of pregnant women in regard to immunizations, breastfeeding, nutrition, child development, and illnesses. Allowing for two-way communication ensures that the health of both pregnant women and their child(ren) are taken care of at an optimal level.
- Regularly train and monitor health workers at health facilities.
- Operational Guidelines and a Package of training on Nutrition Counselling Services with the use of the MCH Record Book should be developed as national standards.
- On-site coaching was necessary for the effective use of the MCH Handbook for nutrition counselling.
- Health workers must use simple language that clients understand and respect client’s needs.
- Special attention is needed for a woman who has reasons or difficulties to seek health services, such as a woman with a sick/weak/small child, one who is poor, one with low literacy, or one who is too young to be pregnant.
- MCH Handbook can be used to educate and empower mothers and promote better care and practices at home. It can be a guide for health care provides to conduct health education and counselling.
SDG 2－Zero hunger
- Target 2.1－By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round.
- Indicator 2.1.1－Prevalence of undernourishment.
- Target 2.2－By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older person.
- Indicator 2.2.1－Prevalence of stunting (height for age <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age.
- Indicator 2.2.2－Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight).
- Indicator 2.2.3－Prevalence of anaemia in women aged 15 to 49 years, by pregnancy status (percentage).
SDG 3－Good health and well-being
- Target 3.1－By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
- Indicator 3.1.1－Maternal mortality ratio.
- Indicator 3.1.2－Proportion of births attended by skilled health personnel.
- Target 3.2－By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
- Indicator 3.2.1－Under-five mortality rate.
- Indicator 3.2.1－Neonatal mortality rate.
- Target 3.7－By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
- Indicator 3.7.1－Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods.
- Indicator 3.7.2－Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group.
- Target 3.8－Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
- Indicator 3.8.1－Coverage of essential health services.
SDG 2－Zero hunger
- Target 2.1－By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round.
- Indicator 2.1.1－Prevalence of undernourishment.
- Target 2.2－By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older person.
- Indicator 2.2.1－Prevalence of stunting (height for age <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age.
- Indicator 2.2.2－Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight).
- Indicator 2.2.3－Prevalence of anaemia in women aged 15 to 49 years, by pregnancy status (percentage).
SDG 3－Good health and well-being
- Target 3.1－By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
- Indicator 3.1.1－Maternal mortality ratio.
- Indicator 3.1.2－Proportion of births attended by skilled health personnel.
- Target 3.2－By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.
- Indicator 3.2.1－Under-five mortality rate.
- Indicator 3.2.1－Neonatal mortality rate.
- Target 3.7－By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
- Indicator 3.7.1－Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods.
- Indicator 3.7.2－Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group.
- Target 3.8－Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
- Indicator 3.8.1－Coverage of essential health services.
The Ministry of Health and the Ghana Health Service have developed the Integrated “Maternal and Child Health Record Book” with technical and financial support from Japan International Cooperation Agency (JICA). The work to develop the book started in early 2016 followed by a pretest of the draft book, and a pilot test was carried out in three regions (Upper West, Ashanti and Central) in 2017 to assess the effective utilization of the book in all the different service delivery points. The book was launched for national distribution on March 2018.
All pregnant women can receive a Maternal and Child Health Handbook, which is called MCH Record Book in Ghana, for free at health facilities when her pregnancy is confirmed. One book covers one pregnancy and one child.
Understanding and acceptance of the MCH Handbook are high among mothers and family members. In the development process of the MCH Handbook in Ghana, a pretest of the draft book was conducted to identify the level of understanding, socio-cultural acceptance, attractiveness, compliance/motivation for behavioural changes among mothers, fathers and grandparents. The draft book was modified according to the results of the pretest; as a result, health and nutrition messages are provided with many illustrations so that all women can easily understand them.
- Regularly train and monitor health workers at health facilities.
- Operational Guidelines and a Package of training on Nutrition Counselling Services with the use of the MCH Record Book should be developed as national standards.
- On-site coaching was necessary for the effective use of the MCH Handbook for nutrition counselling.
- Health workers must use simple language that clients understand and respect client’s needs.
- Special attention is needed for a woman who has reasons or difficulties to seek health services, such as a woman with a sick/weak/small child, one who is poor, one with low literacy, or one who is too young to be pregnant.
- MCH Handbook can be used to educate and empower mothers and promote better care and practices at home. It can be a guide for health care provides to conduct health education and counselling.
Maternal and early childhood nutrition; Social care services; Access to basic health care; Prevention and control of micronutrient deficiencies; Prevention, detection and management of malnutrition; Promotion and access to healthy diets, including through education and affordable/subsidized prices
Multi-level governance involving Ghana Health Service Headquarter (Guidance, Budget, Monitoring and supervision), Regional/District Health Directorate (Training, Monitoring and supervision) and Health facilities (Utilization/Implementation)
All the pregnant women (around 1 million out of 1 million) received MCH Record Book in 2021 in Ghana.
Cost indicators:
- A MCH Record book costs around US$1 in Ghana.
- Development partners have been supporting the printing of the MCH Record Book.
- The government of Ghana gradually takes responsibility for securing the budget for the printing of the MCH RB for sustainability.
- In 2021, the National Health Insurance Authority (NHIA) printed 50% of MCH RB (500,000), which is the Government Budget.
- In 2022, National Health Insurance Authority and Birth and Deaths Registry printed 2,500,000 copies and 1,000,000 copies of MCH Record Book were printed by in 2023.
- The Birth and Deaths Registry printed 1,200,000 copies of MCH Record Book in 2024.
Monitoring and Supervision Checklist is available to check the effective use of MCH Record Book for counseling skills.
In monitoring the implementation of the MCH Record Book, three categories of monitoring are carried out:
- Program specific Monitoring and Supportive Supervision (M&S) at all levels
- Integrated Monitoring and Supervision
- On-the-job monitoring and coaching.