Midwifery Workload and Its Effects on Quality Client Care: A Case Study in the Central Region of Ghana

Philip Gyaase *

Nursing and Midwifery Training College, Dunkwa-On-Offin, Ghana.

Emmanuel Boateng Acheampong

Nursing and Midwifery Training College, Dunkwa-On-Offin, Ghana.

David Ben Sampson

Nursing and Midwifery Training College, Dunkwa-On-Offin, Ghana.

Albert Opoku

Nursing and Midwifery Training College, Tepa, Ghana.

*Author to whom correspondence should be addressed.


Introduction: The goal of the project was to analyze and explore the midwifery workload and its effects on clients’ quality care in some selected districts in Central Region.

Methods: Quantitative cross-sectional and exploratory study designs were employed using 388 participants for the quantitative aspect while 12 participants for the qualitative. The target population was all midwives working in the four selected districts. Online structured questionnaire and in-depth interview were the main data collection tools for the study. Data were analysed with SPSS version 23.0. Descriptive and regression with Pearson Chi square and p-value were the main statistical tools for the data analysis.

Results: The daily working hours for the midwives was 7 hours and 6 days per week. The workload for the midwives was higher than normal since the average patient-midwife ration for the district was 7.2:1 while bed-midwife ratio was 5:1. Quality of care was low since most of the indicators were below average (effectiveness of care =32.4%, safety of care =45.3%, efficient use of medical logistics =47.6% and timeliness of care =36.0%). However, maternal and infant mortality rates = 97.6% with average score of 54.8%.The qualitative findings supported the quantitative results.

Conclusions: There was high midwifery workload in the districts as patient-midwife ratio was above the standard of 4:1 which affected quality care negatively. More midwives should be posted to the districts to augment the staff strength of midwives to improve health care at the district level of the Central Region.

Keywords: Midwifery, workload, effects, quality care, client, central region of Ghana

How to Cite

Gyaase , P., Acheampong , E. B., Sampson , D. B., & Opoku , A. (2023). Midwifery Workload and Its Effects on Quality Client Care: A Case Study in the Central Region of Ghana. Asian Research Journal of Gynaecology and Obstetrics, 6(1), 58–73. Retrieved from https://journalarjgo.com/index.php/ARJGO/article/view/170


Afaya A, Yakong VN, Afaya RA, Salia SM, Adatara P, Kuug AK et al. A qualitative Study on women’s experiences of Intrapartum Care at Tamale Teaching Hospital, Ghana. J Caring Sci. 2017;6(4):303-14.

Allen S, Chiarella M, Homer CSE. Lessons learned from measuring safety culture: an Australian case study. Midwifery. 2010; 26(5):497-503.

Asamani JA, Amertil NP, Ismaila H, Francis AA, Chebere MM, Nabyonga-Orem J. Nurses and midwives demographic shift in Ghana – the policy implications of a looming crisis. Hum Resour Health. 2019;17(1):32.

Bowers J, Cheyne H, Mould G, Page M. Continuity of care in community midwifery. Health Care Manag Sci. 2015;18(2):195-204.

Burchinal M. Measuring early care and education quality. Child Dev Perspect. 2018;12(1):3-9.

Cai X, Wardlaw T, Brown DW. Global trends in exclusive breastfeeding. Int Breastfeed J. 2012;7(1):12.

Colla JB, Bracken AC, Kinney LM, Weeks WB. Measuring patient safety climate: a review of surveys. Qual Saf Health Care. 2005;14(5):364-6.

Craymah JP, Oppong RK, Tuoyire DA. Male involvement in maternal health care at Anomabo, Central Region, Ghana. Int J Reprod Med. 2017;2017:2929013.

Grossbart SR, Agrawal J. Conceptualization and definitions of quality. Health care quality: the Clinician’s Primer; 2001.

Gungor I, Beji NK. Development and psychometric testing of the scales for measuring maternal satisfaction in normal and caesarean birth. Midwifery. 2012;28(3):348-57.

Hanefeld J, Powell-Jackson T, Balabanova D. Understanding and measuring quality of care: Dealing with complexity. Bull World Health Organ. 2017;95(5):368-74.

HAWTHORN J. Measuring quality of life. Eur J Cancer Care. 1993;2(2):77-81.

Hoi SY, Ismail N, Ong LC, Kang J. Determining nurse staffing needs: The workload intensity measurement system. J Nurs Manag. 2010;18(1):44-53.

Holland ML, Holland ES. Survey of Connecticut nurse-midwives. J Midwifery Womens Health. 2007;52(2):106-15.

Homer CSE. Models of maternity care: evidence for midwifery continuity of care. Med J Aust. 2016;205(8):370-4.

Institute for health care Improvent. A guide to measuring the triple aim: A guide to measuring the triple aim: population health, experience of care, and Perca pita Cost; 2012.

International Confederation of Midwives. Philosophy and model of midwifery care. Strengthening midwifery Golbally; 2014.

Jacobs DM, Starkman GD, Lynn BW. Macro dark matter. Mon Not R Astron Soc. 2015;450(4):3418-30.

Käthner I, Wriessnegger SC, Müller-Putz GR, Kübler A, Halder S. Effects of mental workload and fatigue on the P300, alpha and theta band power during operation of an ERP (P300) brain-computer interface. Biol Psychol. 2014;102:118-29.

Kurata YB, Bano RMLP, Matias AC. Effects of workload on academic performance among working students in an undergraduate engineering program. Procedia Manuf. 2015;3:3360-7.

Kvist LJ, Damiati N, Rosenqvist J, Sandin-Bojö AK. Measuring the quality of documented care given by Swedish midwives during birth. Midwifery. 2011;27(6):e188-94.

Mahmood T, Dhillon C. Key indicators. In: Models of care in Maternity Services; 2010.

McCormick A. Quality of life. In: Cerebral palsy: A multidisciplinary approach. 3rd ed; 2018.

McDowell I. Measuring Health: A guide to rating scales and questionnaires. In: Measuring health: A guide to rating scales and questionnaires; 2009.

Morris C, Bailey K. Measuring health care quality: an overview of quality measures. Health Syst Improv; 2014.

Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM. ’They treat you like you are not a human being’: maltreatment during labour and delivery in rural northern Ghana. Midwifery. 2014;30(2):262-8.

Namaganda G, Oketcho V, Maniple E, Viadro C. Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda. Hum Resour Health. 2015;13:89.

Neuraz A, Guérin C, Payet C, Polazzi S, Aubrun F, Dailler F et al. Patient mortality is associated with staff resources and workload in the icu: A multicenter observational study. Crit Care Med. 2015;43(8):1587-94.

Ningsih DA. Midwifery continuity of care. Oksitosin Kebidanan, Agustus. Continuity. 2017;4(2):67-77.

Raven JH, Tolhurst RJ, Tang S, van den Broek N. What is quality in maternal and neonatal health care? Midwifery. 2012;28(5):e676-83.

RCM. High quality midwifery care. Royal College of Midwives; 2014.

Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF et al. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet. 2014;384(9948):1129-45.

Roosam T. International profiles of health care systems 2020. N Engl J Med. 2020;372(1):75-6 (Commonwealth Fund, June 2020).

Roberts M, Mogan C, Joseph B. A. An overview of Ghana’s mental health system: results from an assessment using the World Health Organization’s AssessmentInstrument for Mental Health Systems (WHO-AIMS). Int J Ment Health Syst; 2018.

Tampah-Naah AM, Kumi-Kyereme A. Determinants of exclusive breastfeeding among mothers in ghana: A cross-sectional study. Int Breastfeed J. 2013;8(1):13.

Van Bogaert P, Peremans L, Van Heusden D, Verspuy M, Kureckova V, Van de Cruys Z et al. Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: A mixed method study. BMC Nurs. 2017;16:5.

Van Den Oetelaar WFJM, Van Stel HF, Van Rhenen W, Stellato RK, Grolman W. Balancing nurses’ workload in hospital wards: Study protocol of developing a method to manage workload. BMJ Open. 2016;6(11):e012148.

Weissman JS, Rothschild JM, Bendavid E, Sprivulis P, Cook EF, Evans RS et al. Hospital workload and adverse events. Med Care. 2007;45(5):448-55.

WHO. Trends in maternal mortality: 2000 to 2017: estimates by WHO. UNICEF, UNFPA, World Bank group and the United Nations population division. Geneva: World Health Organization.

WHO. Workload indicators of staffing need. World Health Organization; 2010; 2019.

Wiegers TA. Workload of primary-care midwives. Midwifery. 2007;23(4):425-32.

World Health Organization. Workload indicators of staffing need: User’s manual. World Health Organization; 2010.

WHO. Strategies towards ending preventable maternal mortality (EPMM). Geneva: World Health Organization; 2018. Available:http://www.nhis.gov.gh/News/nhis-active-membership-soars-5282.Accessed;28/11/ 20@8:48pm