In spite of Ghana’s rapid economic growth, development gaps persist between rural and urban areas, between higher and lower income quintiles, and between key development indicators, raising concerns about equity and long-term sustainability of growth. This gap is especially evident in such important health indicators as maternal, infant, and child mortality. While the government has made a major effort to expand access to healthcare services — launching the Ghana National Health Insurance Scheme (NHIS) — access in rural areas is limited.
Private maternity homes (PMHs) have been an important provider of maternal child health care, especially in rural areas. Over the past decade, however, this sector has been in steady decline. Established midwives have aged, closed facilities, and struggled under the NHIS.
The Nyame Tse Ase (“God is Alive”) Maternity Home recently dealt with such a transition. Located in Ghana’s Central Region, the facility was founded in 1996 by Ms. Philippa Eyison, a practicing midwife, who served as owner, manager, and primary clinician for 19 years. At her death in 2015, she left the facility to her son, Mr. Alex Biney. Without a full-time midwife, however, the facility was unable to deliver maternal, child, and newborn health services. Client numbers began to fall and revenue declined; NHIS accreditation was withdrawn due to the lack of a qualified clinician. But closing the facility would deprive the local community of a valuable health resource. Mr. Biney, a banker, believed that with adequate staffing, the facility could be a profitable enterprise — but he was unable to identify a suitable midwife.
At that point, Mr. Biney was contacted by the United States Agency for International Development (USAID)-funded Saving Maternity Homes in Ghana (SMH) project implemented by Banyan Global, in partnership with the Ghana Registered Midwives Association (GRMA). This project is piloting an innovative approach to revitalize the private maternity sector in underserved areas, by catalyzing business transformations. The project team identifies PMHs that are experiencing difficulties, due to the retirement or death of the owner or meeting the requirements of the NHIS. By supporting these facilities in creating business transformations, the SMH project helps ensure the long-term viability of PMHs and promotes increased access, greater efficiency, and enhanced quality of maternal-child healthcare in rural areas.
Banyan Global provides training to PMH facility managers in succession planning; it also brokers business transformations through the sale or leasing of a facility or by bringing in a new partner, manager, or specialist, often aiming to diversify its service offerings. The project supports these newly transformed facilities with business and clinical training, and a small grants program supplements external and personal investments in the facilities.
The SMH project learned about Mr. Biney and the Nyame Tse Ase facility through GRMA’s network. The team then introduced Mr. Biney to Ms. Dina Cobbinah, a midwife who had recently retired from the public sector. They both quickly recognized that Ms. Cobbinah was an excellent match for Nyame Tse Ase. Ms. Cobbinah signed a management contract in November 2016, becoming the maternity home’s primary clinician and manager —thus transforming the failing enterprise. The project also provided clinical and business training, as well as a small grant to purchase equipment to improve maternal and child health. This business transformation, and the improvements in service, led to the reinstatement of NHIS accreditation. The facility has also seen a steady increase in client visits and revenue.
“The SMH project support . . . along with the various technical assistance provided and the reinstatement of Nyame Tse Ase NHIS accreditation, will help the facility to continue with reviving and repositioning itself as a preferred health care center.”
— Mr. Alex Biney, owner of Nyame Tse Ase Maternity Home
To date, the SMH project has facilitated 22 transformations for facilities similar to Nyame Tse Ase Maternity Home. In addition, it has provided clinical and business skills trainings to 418 PMH staff representing 149 facilities. Banyan Global is conducting operations research in order to better understand the power of business transformation in improving and expanding maternal child health services in rural areas.