Barriers to Compliance with Quality of Care Standards in Ghana

Background: Clinical practice guidelines assist providers to make evidence-based decisions and are used in all international contexts. In many countries, including Ghana, the degree to which providers know what the standards and guidelines are in the reproductive and child health arena is unclear. The objective of this study was to gather data on the availability of the national standards in reproductive and child health and providers' adherence to these standards. Design/Methods: This cross-sectional study was conducted June and July 2007. Results are from an anonymous self-administered survey (n=585) distributed to a sample of clinical staff who provide reproductive and child health services in 200 health facilities in southern and central Ghana. Results/Outcomes: Results indicate high levels of support for standards and a strong awareness of what the standards are. 92% of respondents agreed that ‘standards can be easily understood.' Yet only 51% agreed that ‘providers generally follow standards.' Access to copies of standards is a major concern. For four of the five standards manuals referenced in the survey, less than half of respondents had a copy. More worrying, up to 38% of providers felt that treating clients without referring to standards was always or sometimes a problem. Conclusions: An implementation gap remains between the standards as conceived by national committees and the realities experienced by providers on the ground. The main limitations appear to be a lack of orientation on standards and the supervision to ensure adherence to standards. Interventions to improve the quality of care should target these factors and take a holistic approach.