title: Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.
abstract: Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.
authors.affiliation: a Regional Health Directorate , Ghana Health Service , Bolgatanga , Upper East Region , Ghana.|b Swiss Tropical and Public Health Institute , Socinstrasse , Basel , Switzerland (associated with University of Basel, Peterplatz, Basel, Switzerland).
authors.forename: John Koku
authors.initials: JK
authors.lastname: Awoonor-Williams
authors.affiliation: c Averting Maternal Death & Disability , Columbia University, Mailman School of Public Health , New York City , NY , USA.|d FHI 360 , Durham , North Carolina , USA.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Bailey
authors.affiliation: e Navrongo Health Research Centre , Navrongo , Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Yeji
authors.affiliation: a Regional Health Directorate , Ghana Health Service , Bolgatanga , Upper East Region , Ghana.
authors.forename: Ayire Emmanuel
authors.initials: AE
authors.lastname: Adongo
authors.affiliation: f Regional Hospital of Bolgatanga , Bolgatanga , Ghana.
authors.forename: Peter
authors.initials: P
authors.lastname: Baffoe
authors.affiliation: g War Memorial Hospital , Navrongo , Ghana.
authors.forename: Afua
authors.initials: A
authors.lastname: Williams
authors.affiliation: c Averting Maternal Death & Disability , Columbia University, Mailman School of Public Health , New York City , NY , USA.|d FHI 360 , Durham , North Carolina , USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mercer
mesh_terms: D054869:Clinical Audit / Q000379:methods / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005869:Ghana; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D000068101:Maternal-Child Health Services / Q000592:standards / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000628:therapy*; D010360:Patient Transfer / Q000592:standards / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000379:methods
keywords: Ghana; audit; facilitation of referral; maternal and newborn referrals; referral