title: Using quality improvement methods to test and scale up a new national policy on early post-natal care in Ghana.
abstract: BACKGROUND
  The first week of life presents the greatest risk of dying for a young infant. Yet, due to the sociocultural, financial, geographical and health system barriers found in many resource-poor settings, infants do not access health care until much later. To reduce neonatal mortality, the Ghana Health Service proposed a new policy that promotes skilled care during the first week of life. We report the results of an initiative that uses quality improvement (QI) methods to test the feasibility and effectiveness of the new early post-natal care (PNC) policy and its subsequent scale-up throughout northern Ghana.
  
  
  METHODS
  Over a 10-month period, 30 networked QI teams from 27 rural health facilities developed and tested both facility-based and community-based changes to their processes of maternal and neonatal care. Coverage and outcome data were analysed using an interrupted time-series design.
  
  
  RESULTS
  Over 24 months, early PNC increased from a mean of 15% to 71% for visits within the first 48 h, and from 0% to 53% for visits on Day 6 or 7. We observed a slower increase in skilled delivery (mean of 56% to 82%) over a longer period of time (35 months). Facility-based neonatal mortality remained unchanged: mean of 5.1 deaths per 1000 deliveries. Using the most effective change ideas developed in the 27 test facilities, the early PNC policy was scaled up over the subsequent 2 years to 576 health facilities in all 38 districts of northern Ghana.
  
  
  CONCLUSIONS
  This initiative demonstrates the utility of a QI approach in testing, implementing and subsequent scaling up a national policy for early PNC in a resource-constrained setting. This approach provides a model for improving the implementation of other national health policies to accelerate the achievement of the Millennium Development Goals in Ghana and other resource-poor countries.
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Nana Ay
authors.initials: NA
authors.lastname: Twum-Danso
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Ireneous N
authors.initials: IN
authors.lastname: Dasoberi
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Isaac A
authors.initials: IA
authors.lastname: Amenga-Etego
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Ane
authors.initials: A
authors.lastname: Adondiwo
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Kanyoke
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Boadu
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Solomon
authors.initials: S
authors.lastname: Atinbire
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Balagumyetime
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Francisca
authors.initials: F
authors.lastname: Bagni
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Chrysanthus
authors.initials: C
authors.lastname: Kubio
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana.
authors.forename: Isabella
authors.initials: I
authors.lastname: Sagoe-Moses
authors.affiliation: Institute for Healthcare Improvement, 20 University Road, 7th floor, Cambridge, MA 02138, USA, National Catholic Health Service, P.O. Box KA 9712, Accra, Ghana and Ghana Health Service, PMB Ministries, Accra, Ghana pbarker@IHI.org.
authors.forename: Pierre M
authors.initials: PM
authors.lastname: Barker
mesh_terms: D002648:Child; D002662:Child Health Services / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006268:Health Facilities; D006291:Health Policy; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D011181:Postnatal Care / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement; D055815:Young Adult
keywords: Ghana; Quality improvement; implementation science; large-scale change; neonatal mortality; post-natal care