Online Program

Improving the quality of maternal and newborn care through collaborative audit in northern Ghana

Monday, November 4, 2013

Francis Yeji, Msc, Ghana Health Service, Navrongo Health Research Centre, Navrongo, Ghana
Ernest Cudjoe Opoku, MD, MPH, Upper East Regional Health Administration, Ghana Health Service, Upper East Region, Ghana
Peter Baffoe, Obstetrician/Gynaecologist, Bolgatanga Regional Hospital, Bolgatanga, Ghana
Afua Williams, MPH, Ghana Health Service, War Memorial Hospital, Navrongo, Ghana
Emmanuel Ayire, Ghana Health Service, Upper East Region, Bolgatanga, Ghana
Background: A well functioning referral system is an essential element of Safe Motherhood interventions. It inspires confidence and rapid decision making to seek medical care, enabling women with pregnancy complications to quickly reach facilities where high-quality obstetric care is provided. Audit identifies deficiencies and addresses them, but rarely has been applied to maternity referral systems Objectives: To document inter-facility referral practices, enabling health worker to identify weaknesses within their networks, and test solutions to improve the process and quality of maternal and newborn care. Design: Five study teams from 16 facilities (12 health centers, 3 district hospitals and a regional hospital) in 4 districts of Northern Ghana participated in two audit cycles. First, a series of meetings were held with study teams to provide a framework for the implementation of the referral audit cycle. Meetings were attended by the regional and district health teams, facility directors and the midwives; they were used to train midwives, foster understanding and buy-in to the audit process. The audit cycle involves data collection, analysis, action plan formulation, implementation, and reassessing the situation with another cycle. Results: 446 obstetric emergency cases were enrolled in both cycle 1 and 2; 90% were mothers. Unavailable definitive treatment, key staff absent and midwives lacking confidence etc were the main reasons for referrals.Cycle 2,showed improvement in the referral process and quality of care over cycle 1 results. Conclusion: The auditing and strengthening of the maternal and newborn referral system can improve in quality of care

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Assessment of individual and community needs for health education
Basic medical science applied in public health
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Explain the referral process and how health workers can identify weaknesses within the referral system. Describe how collaborative referral audit of emergency obstetric cases, could address the weaknesses, and strengthen the referral system to improve quality maternal and newborn health care

Keyword(s): Maternal and Child Health, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: i am a senior scientist at the Navrongo Health Research Centre, Ghana Health Service, and played leading roles in several research works including the Mobile Technology for Community Health-MOTECH. Maternal and newborn care, mHealth and health systems reforms are my interest areas. I hold and MSc Med (Epidemiology and Biostatistics) from the Wits Unversity, Johannesburg South Africa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.