The QI approach of testing and implementing simple and low cost locally inspired changes has the potential to lead to improved health outcomes at scale both in Ghana and other low- and middle-income countries.

The primary successes for the project so far include broad and deep adoption of QI by local stakeholders for improving system performance, widespread capacitation of leaders, managers and frontline providers in QI methods, incorporation of local ideas into change packages and successful scale-up to approximately 25% of the country's districts in 3 years. Implementation challenges include variable leadership uptake and commitment at the district level, delays due to recruiting and scheduling barriers, weak data systems and repeated QI training due to high staff turnover.

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.

Background The Upper West region of Ghana is mostly made up of rural communities and is highly endemic for lymphatic filariasis (LF), with a significant burden of disability due to lymphedema and hydrocele. The aim of this paper is to describe an enhanced, evidence-based cascading training program for integrated lymphedema management in this region, and to present some initial outcomes. Main text A baseline evaluation in the Upper West Region was carried out in 2019. A cascaded training program was designed and implemented, followed by a roll-out of self-care activities in all 72 sub-districts of the Upper West Region. A post implementation evaluation in 2020 showed that patients practiced self-care more frequently and with more correct techniques than before the training program; they were supported in this by health staff and family members. Conclusions Self-care for lymphedema is feasible and a program of short workshops in this cascaded training program led to significant improvements. Efforts to maintain momentum and sustain what has been achieved so far, will include regular training and supervision to improve coverage, the provision of adequate resources for limb care at home, and the maintenance of district registers of lymphedema cases, which must be updated regularly.

Background Routine Health Information Systems (RHIS) are important for not just sure enough control of malaria, but its elimination as well. If these systems are working, they can extensively provide accurate data on reported malaria cases instead of presenting modelled approximations of malaria burden. Queries are raised on both the quality and use of generated malaria data. Some issues of concern include inaccurate reporting of malaria cases as well as treatment plans, wrongly categorizing malaria cases in registers used to collate data and misplacing data or registers for reporting. This study analyses data quality concerning health staff’s proficiency, timeliness, availability and data accuracy in the Sissala East Municipal Health Directorate (MHD). Methods A cross-sectional design was used to collect data from 15 facilities and 50 health staff members who offered clinical related care for malaria cases in the Sissala East MHD from 24th August 2020 to 17th September 2020. Fifteen health facilities were randomly selected from the 56 health facilities in the municipality that were implementing the malarial control programme, and they were included in the study. Results On the question of when did staff receive any training on malaria-related health information management in the past six months prior to the survey, as minimal as 13 out of 50(26%) claimed to have been trained, whereas the majority 37 out of 50 (74%) had no training. In terms of proficiency in malaria indicators (MI), the majority (68% - 82%) of the respondents could not demonstrate the correct calculations of the indicators. Nevertheless, the MHD recorded monthly average timeliness of the 5th day [range: 4.7–5.7] within the reporting year. However, the MHD had a worse average performance of 5.4th and 5.7th days in July and September respectively. Furthermore, results indicated that 14 out of 15(93.3%) facilities exceeded the target to accomplish report availability (> = 90%) and data completeness (> = 90%). However, the verification factor (VF) of the overall malaria indicator showed that the MHD neither over-reported nor under-reported actual cases, with the corresponding level of data quality as Good (+/-5%). Conclusions The Majority of staff had not received any training on malaria-related RHIS. Some staff members did not know the correct definitions of some of MI used in the malaria programme, while the majority of them could not demonstrate the correct calculations of MI. Timeliness of reporting was below the target, nevertheless, copies of data that were submitted were available and completed. There should be training, supervision and monitoring to enhance staff proficiency and improve the quality of MI.

Background and methodology In districts where lymphatic filariasis (LF) is endemic, the goal is to provide 100% geographical coverage of the essential package of care. Additionally, countries seeking elimination status must document the availability of services for lymphoedema and hydrocele in all endemic areas. To do this, the WHO recommends conducting assessments of the readiness and quality of services provided to identify service delivery and quality gaps. This study used the recommended WHO Direct Inspection Protocol (DIP), which consists of 14 core indicators related to LF case management, medicine and commodities, staff knowledge and patient tracking. The survey was administered in 156 health facilities across Ghana designated and trained to provide LF morbidity management services. Patient and health provider interviews were also conducted to assess challenges and feedback. Principal findings The highest performing indicators across the 156 surveyed facilities were related to staff knowledge; 96.6% of health workers correctly identified two or more signs and symptoms. The lowest scoring indicators concerned medication availability, with the two lowest scoring indicators in the survey being availability of antifungals (26.28%) and antiseptics (31.41%). Hospitals performed best with an overall score of 79.9%, followed by health centers (73%), clinics (67.1%) and CHPS compounds (66.8%). The most commonly reported challenge from health worker interviews was lack of medications and supplies, followed by a lack of training or poor motivation. Conclusions and significance The findings from this study can help the Ghana NTD Program identify areas of improvement as they seek to achieve LF elimination targets and continue to improve access to care for those with LF-related morbidity as part of overall health systems strengthening. Key recommendations include prioritizing refresher and MMDP training for health workers, ensuring reliable patient tracking systems, and integrating lymphatic filariasis morbidity management into the routine healthcare system to ensure medicine and commodity availably.