Barriers to sustainable manual vacuum aspiration (MVA) supply in Ghana: A summary of the results of my 2007 Bixby summer internship
Maura W. Graff
December 2007
Multiple studies have demonstrated that manual vacuum aspiration (MVA) is ideal for surgical uterine evacuation in low-resource settings such as Ghana. In Ghana, an estimated 30% of women experience an unsafe abortion and it is a leading cause of maternal death. Prevention and emergency treatment of life-threatening complications from unsafe abortion is essential to reduce maternal mortality, and to achieve Ghana’s MDGs for 2015.
Established in July 2006, the Reducing Maternal Morbidity and Mortality (R3M) Program is a consortium of 5 agencies (EngenderHealth, Ipas, Population Council, Marie Stopes International, and the Willows Foundation) collaborating with the Ghana Health Service (GHS) to reduce death due to unsafe abortion and to scale-up comprehensive abortion care (CAC) including postabortion care (PAC) and family planning (FP). From June through August, 2007, an intern for the R3M Program gathered information about MVA availability in seven out of ten regions of Ghana. The goal of the research was to identify barriers to sustainable MVA supply. Information was obtained through background literature, unpublished data and reports, and 70 informational interviews with people involved with MVA policy, manufacturing, procurement, distribution, supply, training, and provision. To date, this study is the most extensive qualitative assessment of barriers to MVA sustainability in any country.
The findings revealed that despite consensus about the dire need for MVA in Ghana, developing sustainable access to MVA instruments has proven difficult. Although many organizations have invested significant effort and resources to train providers, a widespread problem is procurement and availability of MVA equipment. Since MVA was introduced in Ghana, and MVA trainings were incorporated into the Safe Motherhood Program in the mid-1990s, supply has been provided either through a reliance on free equipment or by limited private retailers in urban areas. In the public and the private health sectors, procuring MVA equipment has been particularly challenging for low-income, low-volume service providers. Without access to MVA, providers use dilation and curettage to treat PAC patients, or refer women to other health facilities that are often far away.
The following are ten recommendations to improve sustainable access to MVA: (1) Enable all MVA models to be available on the market; (2) Encourage competition on the market; (3) Lower the cost of MVA equipment; (4) Disseminate information about the abortion law in Ghana; (5) Improve GHS monitoring and supervision of MVA; (6) Fund more MVA trainings and supply with international donor assistance; (7) Incorporate more information into trainings and resources about where to purchase MVA equipment and other types of MVA equipment on the market; (8) Continue collaborative efforts between the public and private sectors to expand access to MVA; (9) Make resources/donations readily available for providers who cannot afford MVA equipment; (10) Implement a revolving purchase mechanism (RPM) for the Ghana Registered Midwives Association (GRMA).
The R3M Program has the potential to reduce greatly the incidence of unwanted pregnancy and unsafe abortion, and has demonstrated substantial progress toward improving MVA availability during the pilot phase. In collaboration with GHS, the R3M Program has the capacity to overcome barriers to supply and procurement that must be addressed to achieve MVA sustainability in Ghana.