Addressing the Third Delay: Scaling Up an Obstetric Triage System to Reduce Delay and Improve the Quality of Care in High-risk Referral Hospitals in Ghana

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Maternal mortality ratios in Ghana referral hospitals remain as high as 957–1,004/100,000 live births, and national newborn mortality rates have stagnated at 27/1,000. Poor outcomes and the dismal quality of care stem from delayed identification of complications upon arrival, as women wait hours or even days for evaluation and treatment. The pilot conducted by Kybele-Ghana's obstetric triage program in a large Ghanaian referral hospital significantly reduced delay and improved maternal and newborn care through systematic operational and clinical capacity-building interventions, and has been locally sustained. With Saving Lives at Birth funding, Kybele-Ghana would work with the Ministry of Health to implement its obstetric triage program in six referral hospitals over two years, ultimately reaching 80 percent of Ghana’s tertiary hospitals. Scale-up will succeed when hospitals embed obstetric triage practices into their protocols, staff procedures and culture under the supervision of local managers, with accountability and ongoing quality verification. Kybele-Ghana anticipates sustained 20-minute-or-less arrival-to-evaluation wait-times, with high-quality assessment and treatment plans. This innovation can significantly reduce “the third delay,” a major contributor to mortality that is a problem for at high-volume, high-risk referral hospitals worldwide.

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