The Accelerate project was set up in Ghana in 2011 to examine the role of clinical decision making support (CDMS) systems in accelerating the Millennium Development Goals (MDG) 4 &5 in Ghana. The project sought to promote reduction in maternal and infant mortality by developing and evaluating multi-level (client, frontline worker, district and national) approaches through basic health systems function strengthening in Ghana.

 

The project, a collaboration involving the Ghana Health Service, the School of Public Health, University of Ghana, Wageningen University and the University Medical Center Utrecht, supported the training of six PhD candidates in health policy, health systems, medical anthropology and clinical epidemiology, through a grant from the Netherlands Organization for Scientific Research (WOTRO).

 

The Accelerate project organized a workshop on 3rd February, 2016 to disseminate the research findings of the four year project on client-representatives, frontline health workers, district health managers, national health policy makers, partners and the press on maternal and neonatal health for multi-level decision making and implementation in Ghana.

 

The dissemination workshop was chaired by Prof. Rick Grobbee of the University Medical Center Utrecht and Prof. Phillip Adongo, on behalf of the Acting Dean for the School of Public Health. The workshop participants included representatives from the Ghana Health Service, health facilities, district health managers, foreign missions and donor agencies such as the Netherlands Embassy and USAID. There were representative participants from the major media houses in Ghana as well, including the Ghana Daily Graphic, the Daily Guide and Ghanaian Times.

 

Prof. K. Koram, the Director of the Noguchi Memorial Institute for medical research gave the opening remarks, stating the relevance of the Accelerate project research both in 2011, and today to effectively address maternal and neonatal morbidity and mortality to achieve the sustainable development goals (SDGs) by 2030

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Prof. Irene Agyepong (Co-PI, Ghana Health Service), in presenting an overview of the Accelerate project, discussed the rationale behind the Accelerate phase-one project emphasizing that it aimed at developing capacity through training and retention of PhD researchers in disciplines such as epidemiology, medical anthropology and health policy and health systems in Ghana whilst addressing MDG 4 and 5 at the basic health systems level.

Dr. Charlotte Gardiner outlined the relevance of the project to the health system’s development to address challenges.

 

Disseminations and Discussion

Dr. Kayode Gbenga (Clinical Epidemiology) presented his research findings on “Individual- and population-based interventions to improve neonatal survival in Ghana”. He emphasized the need for early maternal care seeking and also to comprehensively address community based issues such as poverty, infrastructure deficiency and water supply to improve neonatal health outcomes in Ghana.

Dr. Mary Amoakoh-Coleman (Clinical Epidemiology) presented findings on relevance of Clinical Decision Making Support (CDMS) tools for frontline providers of care on Maternal Health. She discussed the relevance of routine maternal health data, predictors of skilled attendance at delivery, and adherence to first antenatal care guidelines and its implications for provider decision making and also continuous improvement in maternal outcomes.

Ms. Lucy Yevoo (Medical Anthropology) presented findings on “Client influences on

Frontline Health worker(s) clinical decision-making and Maternal and Neonatal Care Health Outcomes”. She elaborated on underlying reasons by patients to not disclose comprehensively routine health information such as poor health worker attitudes as well as lack of privacy in the consulting room, and the effect on provider management and eventual outcome of care. The need for improvement in quality of provider-patient interactions was stressed.

Ms. Matilda Abereso-Ako (Medical Anthropology) presented on “Frontline Health Worker Conflicts, Motivation and Effects on Clinical Decision Making: An Organizational Anthropological Perspective”. She discussed health worker conflicts occurring in our health facilities and their effects on provision of maternal care. She recommended that improved services can only occur if team work and collaboration among staff is encouraged.

Ms. Aku Kwamie (Health Policy) presented her findings on “Realist approaches to district manager decision-making for maternal and newborn health in the Greater Accra Region, Ghana”. She noted that district health manager decision-making space has shrunk over the last decades as a result of resource uncertainty and hierarchy in the health system in Ghana, and that the leadership development program (LDP), which was implemented by the Ghana Health Service (GHS) only improved district manager decision making capability in the short-term but could not institutionalized in the medium term to long term due to resource constraints..

Ms. Augustina Koduah’s findings were on “National maternal health policy agenda setting and outcomes and its implication for maternal and new-born outcomes”. She spoke about contextual factors such as national politics, economic issues and donor funding influencing the agenda setting for maternal and neonatal health policies, which need to be carefully considered for the implementation of effective maternal and neonatal health policies in Ghana.

Dr. Hanna Brown-Amoakoh presented an overview of the Accelerate project’s Phase-two activity, a “Cluster Randomized Controlled Trial (CRCT) to Evaluate the Effect of Mobile Phone-based Intervention for Maternal and Newborn care in Ghanacurrently underway in the Eastern Region of Ghana. The study assesses whether text messaging of standard emergency care protocols to frontline health workers decreased the facility-based incidence of maternal and neonatal morbidity and mortality.

 

The ensuing discussion among the research team and workshop participants centered on the translation of the findings into policy and practice (knowledge translation), and the lessons that will enable attainment of the Sustainable Development Goals (SDGs) in Ghana, a follow-up to the United Nation’s MDGs. Sharing the project findings with a wider audience through policy briefs and engagement with stakeholders at the upcoming National Health Summit of the Ghana Health Service will provide for wider dissemination for policy and practice.