Using quality improvement methods to test and scale up a new national policy on early post-natal care in Ghana

  • Health Policy and Planning, Volume 29, No. 5, Year 2014

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Study Justification:
– The first week of life is the most critical period for infant mortality.
– Existing barriers prevent infants from accessing healthcare during this period.
– The Ghana Health Service proposed a new policy to promote early post-natal care (PNC) during the first week of life.
– This study aims to test the feasibility and effectiveness of the new PNC policy and scale it up throughout northern Ghana.
Highlights:
– Over a 10-month period, 30 quality improvement (QI) teams from 27 rural health facilities developed and tested changes to maternal and neonatal care processes.
– Early PNC increased from 15% to 71% for visits within the first 48 hours, and from 0% to 53% for visits on Day 6 or 7.
– Skilled delivery increased from 56% to 82% over 35 months.
– Facility-based neonatal mortality remained unchanged at 5.1 deaths per 1000 deliveries.
– The most effective change ideas were used to scale up the early PNC policy to 576 health facilities in all 38 districts of northern Ghana.
Recommendations:
– Implement the new early PNC policy nationwide to improve infant healthcare access.
– Continue using quality improvement methods to refine and enhance the policy implementation.
– Address barriers to skilled delivery to further reduce neonatal mortality.
Key Role Players:
– Ghana Health Service
– Rural health facilities
– Quality improvement teams
– Healthcare providers
– Community leaders and volunteers
– Policy makers
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers and quality improvement teams
– Infrastructure and equipment upgrades for health facilities
– Community engagement and awareness campaigns
– Monitoring and evaluation systems
– Data collection and analysis tools
– Policy development and implementation support

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used quality improvement methods to test and scale up a new national policy on early post-natal care in Ghana. The results show significant improvements in early post-natal care coverage, with an increase from 15% to 71% for visits within the first 48 hours and from 0% to 53% for visits on Day 6 or 7. However, the study did not show a significant decrease in facility-based neonatal mortality. To improve the strength of the evidence, future studies could include a control group for comparison and a longer follow-up period to assess the long-term impact of the policy.

Introduction The first week of life presents the greatest risk of dying for a young infant. Yet, due to the sociocultural, financial, geographical and health system barriers found in many resource-poor settings, infants do not access health care until much later. To reduce neonatal mortality, the Ghana Health Service proposed a new policy that promotes skilled care during the first week of life. We report the results of an initiative that uses quality improvement (QI) methods to test the feasibility and effectiveness of the new early post-natal care (PNC) policy and its subsequent scale-up throughout northern Ghana. Methods Over a 10-month period, 30 networked QI teams from 27 rural health facilities developed and tested both facility-based and community-based changes to their processes of maternal and neonatal care. Coverage and outcome data were analysed using an interrupted time-series design. Results Over 24 months, early PNC increased from a mean of 15% to 71% for visits within the first 48 h, and from 0% to 53% for visits on Day 6 or 7. We observed a slower increase in skilled delivery (mean of 56% to 82%) over a longer period of time (35 months). Facility-based neonatal mortality remained unchanged: mean of 5.1 deaths per 1000 deliveries. Using the most effective change ideas developed in the 27 test facilities, the early PNC policy was scaled up over the subsequent 2 years to 576 health facilities in all 38 districts of northern Ghana. Conclusions This initiative demonstrates the utility of a QI approach in testing, implementing and subsequent scaling up a national policy for early PNC in a resource-constrained setting. This approach provides a model for improving the implementation of other national health policies to accelerate the achievement of the Millennium Development Goals in Ghana and other resource-poor countries. © 2013 The Author.

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The recommendation to improve access to maternal health in Ghana is to use quality improvement methods to test and scale up a new national policy on early post-natal care. In a study conducted in rural health facilities, 30 networked quality improvement teams developed and tested changes to their processes of maternal and neonatal care over a 10-month period. The results showed that early post-natal care increased significantly, with visits within the first 48 hours increasing from 15% to 71%, and visits on Day 6 or 7 increasing from 0% to 53%. Skilled delivery also increased from 56% to 82% over a longer period of time. The most effective change ideas were then scaled up to 576 health facilities in all 38 districts of northern Ghana over the subsequent 2 years. This approach demonstrates the effectiveness of using quality improvement methods to test, implement, and scale up national policies for early post-natal care in resource-constrained settings, and provides a model for improving the implementation of other national health policies in Ghana and other resource-poor countries.
AI Innovations Description
The recommendation to improve access to maternal health is to use quality improvement methods to test and scale up a new national policy on early post-natal care in Ghana. This recommendation was implemented in a study where 30 networked quality improvement teams from 27 rural health facilities developed and tested changes to their processes of maternal and neonatal care over a 10-month period. The results showed that early post-natal care increased from 15% to 71% for visits within the first 48 hours, and from 0% to 53% for visits on Day 6 or 7. Skilled delivery also increased from 56% to 82% over a longer period of time. The most effective change ideas developed in the test facilities were then scaled up to 576 health facilities in all 38 districts of northern Ghana over the subsequent 2 years. This approach demonstrates the utility of using quality improvement methods to test, implement, and scale up national policies for early post-natal care in resource-constrained settings, and provides a model for improving the implementation of other national health policies in Ghana and other resource-poor countries.
AI Innovations Methodology
The methodology used in the study to simulate the impact of the recommendations on improving access to maternal health involved the following steps:

1. Selection of networked quality improvement teams: 30 networked quality improvement teams were selected from 27 rural health facilities in Ghana. These teams were responsible for developing and testing changes to their processes of maternal and neonatal care.

2. Development and testing of changes: The selected teams developed and tested both facility-based and community-based changes to improve early post-natal care. These changes aimed to increase the percentage of visits within the first 48 hours and on Day 6 or 7 after delivery.

3. Data collection and analysis: Coverage and outcome data were collected and analyzed using an interrupted time-series design. This design allows for the evaluation of changes over time by comparing data before and after the implementation of the recommendations.

4. Evaluation of results: The results of the study showed an increase in early post-natal care visits from 15% to 71% within the first 48 hours, and from 0% to 53% on Day 6 or 7. Skilled delivery also increased from 56% to 82% over a longer period of time.

5. Scaling up of effective change ideas: The most effective change ideas developed in the test facilities were then scaled up to 576 health facilities in all 38 districts of northern Ghana over the subsequent 2 years. This involved implementing the successful changes in a larger number of facilities to improve access to maternal health on a broader scale.

6. Conclusion and recommendations: The study concluded that using quality improvement methods to test, implement, and scale up national policies for early post-natal care in resource-constrained settings is effective. The approach used in this study can serve as a model for improving the implementation of other national health policies in Ghana and other resource-poor countries.

Overall, the methodology involved selecting teams, developing and testing changes, collecting and analyzing data, evaluating results, scaling up successful changes, and drawing conclusions and recommendations based on the findings.

Statistics:
Citations: 16
Authors: 12
Identifiers:
DOI: 10.1093/heapol/czt048
ISSN: 02681080
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care
Study Countries:
Ghana
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