Celebrate Solutions: Improving Reproductive and Child Health Services in Ghana

By: Smita Gaith, Women Deliver

In Ghana, 350,000 women and 57,000 children under five die each year. Access to quality, comprehensive health care could have saved many of these lives.  In response, from 2005 – 2009, the Quality Health Partners project (QHP) was put in place to support efforts that were already under way in Ghana to ensure high quality reproductive and child health services. The project allowed for the integration of both the public and private sector, and covered several areas of health: family planning; reproductive health; maternal and child health; HIV and AIDS prevention, care, and treatment; malaria prevention and treatment; and infectious disease surveillance. 

QHP focused on 37 deprived districts with a high prevalence of HIV, and took place in 200 major public health facilities in Ghana. The goals of the project were to empower women and men to demand, influence, pay for, and use quality reproductive and child health (RCH) services; create a network of efficient, high quality RCH services at both public and private facilities with an effective referral system; inform health care providers to be more gender-sensitive and implement best practices in their work; and support the Ghana Health Service/Ministry of Health’s institutionalization of quality assurance at all levels of government.

The Ministry of Health and Ghana Health Service worked with managing partner EngenderHealth, and funder US AID, to improve national service delivery protocols, guidelines, and training curricula for health care providers. Specifically, the project led to development, dissemination and implementation of standards and guidelines, provision of equipment and supplies, and capacity building of staff through trainings and supervision. The project was evaluated in December 2004 and September 2007 and finally in September 2009 to measure progress and areas of improvement.

By the final assessment, the project was boasting many accomplishments in each program area.

  • An increase from 35.1 percent to 60 percent of facilities with quality assurance teams
  • Increases in provider assurance of patient confidentiality and privacy; 21 percent increased to 61 percent in family planning, and an increase from 58 percent to 92 percent in delivery areas
  • An increase from 33 percent to 70 percent of providers telling caregivers what sickness their children have, and an increase from 40 percent to 93 percent describing the dosage of medicine to give to treat a patient.
  • Increased provider knowledge of neonatal care.
  • Improved infection prevention measures in all services areas, from 31 percent at the start of the project, to 46 percent at the end of the project. Individual services areas including Child health, family planning, antenatal care and deliver all varied in their increased infection prevention.
  • Moderately increased sustainability of the Integrated Disease Surveillance and Response model for disease surveillance instituted in the first half year of QHP’s work. At baseline 48 percent of districts had a disease outbreak, compared to 14 percent at baseline; and an increase to 81 percent of service providers completing weekly report from 21 percent at project start.

In completing the project, QHP also worked with Ghana Health Service to identify data needs, and design and introduce a simplified set of common quarterly reporting forms.  Additionally, a bottom-up approach in improving skills and systems, and a basic health services package was supported, making decentralized decision-making, a more efficient way of decision making, successful.

Some areas that QHP identified for improvement are in staff shortages and equipment shortages, but found that the overall program, having increased capacity, should be able to improve with time.

Flickr photograph via ReSurge International.

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