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