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Accelerating Spread of Community-Based Strategies to Reduce Maternal, Newborn and Child Health Challenges in Ghana

Accelerating Spread of Community-Based Strategies to Reduce Maternal, Newborn and Child Health Challenges in Ghana. by Nana A. Y. Twum-Danso, MD, MPH Director, Project Fives Alive! Institute for Healthcare Improvement

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Accelerating Spread of Community-Based Strategies to Reduce Maternal, Newborn and Child Health Challenges in Ghana

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  1. Accelerating Spread of Community-Based Strategies to Reduce Maternal, Newborn and Child Health Challenges in Ghana by Nana A. Y. Twum-Danso, MD, MPH Director, Project Fives Alive! Institute for Healthcare Improvement 5th Annual International Conference of the African Science Academy Development Initiative La Palm Royal Beach Hotel, Accra, Ghana November 10-11, 2009

  2. Presentation Outline • Background • Successful Community-Based Strategies • Summary

  3. BACKGROUND

  4. Background (1/6):Aim of Project Fives Alive! Assist and accelerate Ghana's faith-based and public health services efforts to achieve MDG4 through the application of quality improvement methods

  5. Background (2/6): Drivers of Under-5 Deaths in Ghana

  6. Resources  Background (3/6): Enablers of Under-5 Survival in Ghana Knowledge & Training Systems Approach  

  7. Background (4/6): QI Strategies - The Model for Improvement • Method of continuous quality improvement • Provides a framework work for developing and testing change ideas, learning and re-design • Emphasizes small changes that are non-threatening and non-disruptive • Relies on input and ideas from frontline providers Source: Associates for Process Improvement

  8. Background (5/6): QI Strategies – Improvement Collaborative Network Wave 1 26 clinics & 2 hospitals from 4 districts/dioceses Jul’08 to present Start Small, Accelerate Learning & Scale-up Rapidly

  9. Background (6/6): Focus of QI Work • Care Pathway

  10. SELECTION OF SUCCESSFUL STRATEGIES

  11. Antenatal Care: Activate CBVs to identify pregnant women in community early, provide health education, refer to clinic for ANC, midwife follows-up NHI free for maternity & early infant care; small scale testing of pregnancy registers

  12. Skilled Delivery: Engage TBAs to accompany labouring women to health facility; TBA can stay and serve as delivery companion

  13. Skilled Delivery: Engage chiefs & elders on risks of labour and delivery & enlist their help in promoting skilled delivery

  14. Skilled Delivery: Video show in community on risks of unskilled delivery followed by Q&A session and health promotion

  15. Skilled Delivery: Mobile telephone contact between labouring women and health staff for transport or domiciliary midwifery

  16. Postnatal Care: Home visits by health staff on Day 1 or 2 for neonates born at home and home visits on Day 6 or 7 for all neonates

  17. Postnatal Care: Home visits by CBVs on Day 4 to screen for danger signs and remind mothers to follow up at health center on Day 6 or 7

  18. Change Package: Development of a change package for scale up • Data were collected on each change idea tested • 6 to 12 months of baseline data and at least 6 months of post-intervention data • Used time-series analysis to determine successful change ideas. • Developed strict criteria for determining successful change ideas:

  19. Scaling Up Change Package • Change Package Wave 2 ~300 QI teams from 38 districts Sept’09 to Jun’11

  20. SUMMARY

  21. Summary • Local knowledge, innovation and testing of changes at the community level can reduce delay in seeking care for MNCH • Local generation and use of data key to: • Frontline health provider empowerment to develop and test changes iteratively for continuous improvement • Improving data quality from primary sources • Processes across care continuum can be accelerated with Improvement Collaborative Network model through: • peer-to- peer learning • deliberate spreading of successful change ideas/best practices • Change package can facilitate spread of local successes or best practices on a large scale to achieve higher coverage and improved health outcomes in non-innovation sites

  22. Can the achievement of MDG4 in Ghana be further accelerated? We believe we can!

  23. Acknowledgements • Team • George B. Akanlu • Isaac A. Amenga-Etego • Ireneous N. Dasoberi • Solomon A. Atinbire • Phoebe Bala • Francisca Bagna • Chrysanthus Kubio • James Tobiga • Pierre M. Barker • Institutions • Ghana Health Service • National Catholic Health Service • Institute for Healthcare Improvement • Bill & Melinda Gates Foundation

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