Absence of clear lines of authority identified as major source of power struggle

The absence of clear lines of authority between frontline health workers in public health facilities has been described as a major source of power struggle impacting negatively on health care delivery.

The power struggle has also resulted in conflicts among these frontline workers and led to frustrations, dis-empowerment and de-motivation of health workers.

Ms Matilda Aberese Ako, Research Officer of the Navrongo Health Research Centre of the Ghana Health Service, said there were no clear lines of authority between frontline health workers, especially doctors and nurse-anaesthetists.

This, she said, has contributed to power struggles between collaborating professionals.

Ms Ako, who researched on “Health Workers Motivation and Attitudes in the Provision of Maternal and Neonatal care in Ghana”, made these findings known at a dissemination workshop in Accra.

Her ethnographic study involved participant observation, in-depth interviews and conversations, also revealed that conflicts contributed to poor collaboration between health professionals in the provision of health care.

The workshop, organised by the School of Public Health of the University of Ghana in collaboration with the Ghana Health Service, formed part of Wotro-Accelerate project, aimed at promoting reduction in maternal and infant mortality by developing and evaluating multi-level approaches for accelerated attainment of MDG 4&5.

The meeting was, therefore, to disseminate final research findings to inform policy makers, partners and stakeholders on evidence regarding what has been achieved through scientific research and its implications for the MDGs and the newly-adopted Sustainable Development Goals (SDGs) in Ghana.

Ms Ako said the motivation of the frontline health worker was vital to quality maternal and neonatal health care provision and there was the need to change policy and organizational design to address their motivation issues.

She said the study which lasted for over 20 months, revealed that national health policies and legislation did not give hospital managers adequate power to make decisions on human and other resources relevant to quality care provision.

“As a result, conflicts among doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital remained unresolved and continued to fester as such staff could not be disciplined.

Such attitudes resulted in among others delayed and postponement in client care, failure in the provision of care to clients and compromised client wellbeing.

The study suggested that to improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur.

      It called for effective mechanisms including training managers and health workers on conflict management to be put in place whilst promotion of communication and interaction among health workers could foster team spirit.

One of the reports showed that pregnant women used various strategies to protect the confidentiality of the medical and reproductive information they exchanged during the history taking process with health officials.

Ms Linda Lucy Yevoo, a Research Officer of the School of Public Health of the University of Ghana (UG), whose 19 month study was on: “Health Worker Attitudes; Its Influence on Pregnant Women’s Decisions and Implications on Quality of Maternal Care in the Greater Accra Region,” said pregnant women primarily misinformed health workers about their reproductive information to avoid healthcare providers’ reprimands and humiliations.

She said that was possible because, during history taking, healthcare providers often showed anger and insulted women or made sarcastic comments when information provided by the pregnant women on their reproductive status did not meet the healthcare provider’s standards and expectations. 

“This was also to prevent them from being humiliated and prevent pregnant women from receiving reprimands from healthcare providers; because of reporting late for antenatal care.

Ms Yevoo called for the urgent need for healthcare workers to improve their attitudes and interactions with clients and refrain from making undesirable comments about them.

She said it was essential for them to improve the level of privacy in their various health facilities since that will instill confidence in the women, to provide the right reproductive and medical information to their healthcare providers.

his, she said, could be achieved by reducing co-consultation practices at the facility level and also introduce a shift system at the antenatal care unit as a way to reduce the number of clients seen by a midwife in a day.

The other researchers also made presentations on various related topics that affected quality health delivery in the hospitals and how they affected women’s health.

They included: Mr Gbenya A. Kayode from the Julius Centre for Health Sciences and Primary Care, who made a presentation on: “Individual and Population-Based Interventions to Improve Neonatal Survival in Ghana”;  another on “Complete Adherence to First Antenatal Care Guidelines Reduces Neonatal and Delivery Complications” by Dr Mary Amankoh-Coleman from the School of Public Health of the University of Ghana.

Other topics were: “Maternal Health Policy Decision-Making in Ghana: The Pivotal Role of Policy Actors and Context” by Ms Augustina Koduah and  “Realist Approaches to District Manager Decision-Making for Maternal and Newborn Health in the Greater Accra Region, Ghana” by Ms Aku Kwamie.

GNA