Building structures and mechanisms to improve maternal and newborn quality of care in Ghana

Ghana

Photo: WHO Ghana A tri-level WHO mission to assess, build capacity, cultivate a shared understanding, and oversee the implementation of network activities within the country.

Elevating maternal and newborn care

For three decades, Ghana has been committed to reducing maternal and child mortality rates, crucial for achieving Sustainable Development Goals 3.1 and 3.2 by 2030. As of 2017, Ghana’s targets involve decreasing the maternal mortality ratio from 310 to fewer than 70 per 100,000 live births, neonatal mortality from 25 to under 12 per 1,000 live births, and under-5 mortality from 52 to fewer than 25 per 1000 live births.[1] Led by the Ministry of Health and the Ghana Health Service, and with technical support from WHO Ghana and UNICEF, the Network for Improving Quality of Care for Maternal, Newborn and Child Health (Quality of Care Network)[2] was launched across seven regions. The Network aims to halve maternal, newborn deaths, and stillbirths using the Leadership, Action, Learning, and Accountability (LALA) framework. While only two of the Network’s fifteen milestones were met in 2017, by 2022 Ghana had achieved 14 milestones by enhancing institutions, mechanisms, strategies, and policies. This contributed to a decrease in institutional stillbirth rates over five years in participating facilities.[3] Ghana’s immediate focus is on securing the final milestone.

WHO's Key Contributions

Established a global vision, framework, and standards in 2015-2016 for improving Maternal and Newborn Health (MNH) Quality of Care (QoC).
Founded the QoC Network Secretariat to help implement these standards by developing technical products and guidelines to enable national QoC initiatives.
Instituted a Leadership Working Group to guide the implementation of the Leadership, Action, Learning, and Accountability (LALA) framework.
Facilitated the adoption WHO’s MNH QoC standards by developing a roadmap, assisting in policy creation.
Provided ongoing technical support to help fast track implementation and QoC measurement at country level, including introducing mechanisms for community and stakeholder participation.

How did Ghana, with the support of WHO, achieve this?

In 2015, WHO articulated a global vision to ensure women, newborns, children, and adolescents have access to comprehensive, high-quality health services. To convert this ambitious vision into measurable results, WHO introduced a comprehensive framework and, in 2016, established standards to improve QoC for Maternal and Newborn Health (MNH) within health facilities. To enable their implementation, WHO established the Quality of Care (QoC) Network in 2017, a collaborative alliance comprising governments, implementation partners, and donors from 11 countries including Ghana, all committed to enhancing QoC.

To align activities within the QoC Network and promote a coordinated approach, WHO founded a Network Secretariat. Since its establishment, this WHO-based Network Secretariat has been crucial in developing and deploying technical products, setting normative guidelines, and hence facilitating the national-level realization of QoC initiatives. It has also forged relationships with a wide array of stakeholders, enabling the provision of technical support and resources to participating countries.

The Network Secretariat instituted a Leadership Working Group as a vital element of its leadership and advocacy strategy. This group, consisting of senior representatives from Ministries of Health within Network countries, assumes a supervisory role, guiding the development and execution of the Leadership, Action, Learning, and Accountability (LALA) framework on both the national and global levels.

Ghana adopted WHO's standards and implementation packages for MNH QoC [4] through a series of strategic steps, aided by the technical assistance of the Network Secretariat and WHO Ghana. As an initial measure, WHO Ghana developed and implemented a comprehensive roadmap for MNH QoC [5], providing clear direction for the initiative's progression. Simultaneously, Ghana's Ministry of Health, in concert with the local WHO office, crafted supportive policies for MNH QoC implementation [6]. These policies currently drive the practical application of QoC at the point of care, incorporating the MNH QoC standards. Additionally, the Network Secretariat provided ongoing technical support based on a set of technical products and tools to help fast track implementation and QoC measurement at country level. To synchronize regions and facilities’ QoC implementation and performance tracking, mechanisms for community and stakeholder participation were launched, including a Community Scorecard [7] to augment care quality and enhance health facility accountability.

Half a decade into these strategic endeavours, concrete results have begun to manifest at the population level. An analysis of impact data submitted to the QoC Network Secretariat, and overseen by WHO, demonstrates a reduction in the institutional stillbirth rate over a 5-year period in participating health facilities [8]. The creation of critical leadership systems, provision of technical support to health institutions, establishment of knowledge exchange platforms, and the fortification of accountability systems have collectively strengthened Ghana's health system's resilience. This proved pivotal during the COVID-19 pandemic, ensuring the uninterrupted delivery of quality maternal, newborn, and child health services. Ghana's unique yet collaborative approach serves as a model for governments and partners endeavouring to embed quality care for maternal and newborn health into their respective health systems.

References

Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF. 2018. Ghana Maternal Health Survey 2017. Ghana Maternal Health Survey 2017, accessed 21 February 2024.
World Health Organization. The Network for Improving Quality of Care for Maternal, Newborn and Child Health (Quality of Care Network) [web portal]. Quality of Care Network, accessed 29 January 2024.
Ghana District Health Information Management System–2 (DHIMS–2).
Ghana maternal and newborn quality of care standards.
National maternal and newborn health quality of care strategic roadmap and operational plan [web portal]. National Maternal and Newborn Health Quality of Care Strategic Roadmap and Operational Plan, accessed 17 February 2024.
Ghana national implementation guide for improving quality of maternal and newborn care in health facilities, June 2019.
Ghana’s Network for Improving Quality of Care for Maternal, Newborn and Child Health (July 2020 - June 2021 Bulletin) [web portal]. Ghana’s Network for Improving Quality of Care for MNCH Bulletin, accessed 17 February 2024.
Ghana Presentation - Global QoC network meeting March 2023 PDF, [web portal]. Global QoC Network Meeting Ghana Report March 2023, accessed 17 February 2024.