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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A nationwide quality improvement project to accelerate Ghana's progress toward millennium development goal four: Design and implementation progress
International Journal for Quality in Health Care, Volume 24, No. 6, Article mzs060, Year 2012
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Description
Quality problem: The gap between evidence-based guidelines and practice of care is reflected, in low- and middle-income countries, by high rates of maternal and child mortality and limited effectiveness of large-scale programing to decrease those rates. Choice of solution: We designed a phased, rapid, national scale-up quality improvement (QI) intervention to accelerate the achievement of Millennium Development Goal Four in Ghana. Our intervention promoted systems thinking, active participation of managers and frontline providers, generation and testing of local change ideas using iterative learning from transparent district and local data, local ownership and sustainability. Implementation: After 50 months of implementation, we have completed two prototype learning phases and have begun regional spread phases to all health facilities in all 38 districts of the three northernmost regions and all 29 Catholic hospitals in the remaining regions of the country. To accelerate the spread of improvement, we developed 'change packages' of rigorously tested process changes along the continuum of care from pregnancy to age 5 in both inpatient and outpatient settings. Lessons learned: The primary successes for the project so far include broad and deep adoption of QI by local stakeholders for improving system performance, widespread capacitation of leaders, managers and frontline providers in QI methods, incorporation of local ideas into change packages and successful scale-up to approximately 25% of the country's districts in 3 years. Implementation challenges include variable leadership uptake and commitment at the district level, delays due to recruiting and scheduling barriers, weak data systems and repeated QI training due to high staff turnover. © The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
Authors & Co-Authors
Twum-Danso, Nana A.Y.
United States, Boston
Institute for Healthcare Improvement
Akanlu, George B.
Ghana, Accra
National Catholic Health Service
Osafo, Enoch
Ghana, Accra
National Catholic Health Service
Sodzi-Tettey, Sodzi
United States, Boston
Institute for Healthcare Improvement
Boadu, Richard O.
Ghana, Accra
National Catholic Health Service
Atinbire, Solomon
Ghana, Accra
National Catholic Health Service
Adondiwo, Ane
Ghana, Accra
National Catholic Health Service
Amenga-Etego, Isaac A.
Ghana, Accra
National Catholic Health Service
Ashagbley, Francis
Ghana, Accra
National Catholic Health Service
Boadu, Eric A.
Ghana, Accra
National Catholic Health Service
Dasoberi, Ireneous N.
Ghana, Accra
National Catholic Health Service
Kanyoke, Ernest
Ghana, Accra
National Catholic Health Service
Yabang, Elma
Ghana, Accra
National Catholic Health Service
Essegbey, Ivan T.
Ghana, Accra
National Catholic Health Service
Adjei, George A.
Ghana, Accra
National Catholic Health Service
Buckle, Gilbert B.
Ghana, Accra
National Catholic Health Service
Koku Awoonor-williams, J.
Ghana, Accra
Ghana Health Service
Nang-Beifubah, Alexis
Ghana, Accra
Ghana Health Service
Twumasi, Akwasi
Ghana, Accra
Ghana Health Service
Joseph Mccannon, C.
United States, Boston
Institute for Healthcare Improvement
Barker, Pierre M.
United States, Boston
Institute for Healthcare Improvement
United States, Chapel Hill
Unc School of Medicine
Statistics
Citations: 49
Authors: 21
Affiliations: 4
Identifiers
Doi:
10.1093/intqhc/mzs060
ISSN:
13534505
e-ISSN:
14643677
Research Areas
Health System And Policy
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Study Locations
Ghana