title: Care decision making of frontline providers of maternal and newborn health services in the greater Accra region of Ghana.
abstract: OBJECTIVE
  To explore the "how" and "why" of care decision making by frontline providers of maternal and newborn services in the Greater Accra region of Ghana and determine appropriate interventions needed to support its quality and related maternal and neonatal outcomes.
  
  
  METHODS
  A cross sectional and descriptive mixed method study involving a desk review of maternal and newborn care protocols and guidelines availability, focus group discussions and administration of a structured questionnaire and observational checklist to frontline providers of maternal and newborn care.
  
  
  RESULTS
  Tacit knowledge or 'mind lines' was an important primary approach to care decision making. When available, protocols and guidelines were used as decision making aids, especially when they were simple handy tools and in situations where providers were not sure what their next step in management had to be. Expert opinion and peer consultation were also used through face to face discussions, phone calls, text messages, and occasional emails depending on the urgency and communication medium access. Health system constraints such as availability of staff, essential medicines, supplies and equipment; management issues (including leadership and interpersonal relations among staff), and barriers to referral were important influences in decision making. Frontline health providers welcomed the idea of interventions to support clinical decision making and made several proposals towards the development of such an intervention. They felt such an intervention ought to be multi-faceted to impact the multiple influences simultaneously. Effective interventions would also need to address immediate challenges as well as more long-term challenges influencing decision-making.
  
  
  CONCLUSIONS
  Supporting frontline worker clinical decision making for maternal and newborn services is an important but neglected aspect of improved quality of care towards attainment of MDG 4 & 5. A multi-faceted intervention is probably the best way to make a difference given the multiple inter-related issues.
authors: Ridge Regional Hospital OPD, Adabraka, Accra, Ghana. ebomens78@yahoo.co.uk
authors: Ebenezer
authors: E
authors: Oduro-Mensah
authors: Aku
authors: A
authors: Kwamie
authors: Edward
authors: E
authors: Antwi
authors: Sarah
authors: S
authors: Amissah Bamfo
authors: Helen Mary
authors: HM
authors: Bainson
authors: Benjamin
authors: B
authors: Marfo
authors: Mary Amoakoh
authors: MA
authors: Coleman
authors: Diederick E
authors: DE
authors: Grobbee
authors: Irene Akua
authors: IA
authors: Agyepong
mesh_terms: D001291:Attitude of Health Personnel; D002662:Child Health Services / Q000458:organization & administration*; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D005869:Ghana; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration