Reducing Maternal and Perinatal Mortality in Ghana by Improving Service Delivery Capacity: Introducing Systematic Quality Improvement Methodologies into the Greater Accra Health Region.

This project expands a 5 year Kybele-Ghana Health Service partnership analyzing systems and patient care processes at Ridge Hospital, a large obstetric referral center in Accra. The partnership addressed leadership, motivation, knowledge deficits, equipment shortage, patient flow and communication problems yielding a 34% decrease in maternal mortality and a 36% decrease in stillbirth, despite a 36% increase in patient admission with higher disease acuity. In order to reduce mortality further, a more systematic approach is required to expand clinical and operational improvements to the primary care clinics which refer to Ridge. The project will build local capability to transform service delivery through the systematic introduction of customized quality improvement methodologies to address process issues affecting maternal-newborn mortality. This methodology, emphasizing real time learning and supported by innovative remote coaching tools was recently piloted at Ridge to reduce delay within a new obstetric operating room demonstrating feasibility for scale. This project extends pilot to the Greater Accra health system to create the infrastructure for on-going continuous improvement to address maternal and neonatal mortality.

We hypothesize that a quality improvement program in the health system will: 1) produce sustainable reductions in critical delays and errors 2) result in greater motivation, problem solving ability and patient safety culture and 3) improve outcomes for mothers and neonates in the Greater Accra Region. Proof of this hypothesis should accelerate maternal and perinatal mortality reduction in Ghana and beyond. At minimum, knowledge will be gained for successful QI introduction in resource-limited contexts.