Abstract:
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.
