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.

“I did not know it was a medical condition”: Predictors, severity and help seeking behaviors of women with female sexual dysfunction in the Volta region of Ghana

“…Though often shrouded in taboo and stigma, research shows that sexual and reproductive health is fundamental to the economic development of nations, to people's health and survival, and to the wellbeing of humanity [42]. Compared to those in urban settings and of higher socio-economic status, women in rural settings, and those of lower socio-economic standing, tend to be more vulnerable to adverse physical, mental, obstetric and gynecological health outcomes [22,[43][44][45][46][47][48][49][50][51][52][53]. They often report poorer self-rated mental and physical health [43,52], have less access to necessary obstetric care [22,46,47,50], and have higher rates of trauma and mortality [23,24,46,[54][55][56][57][58][59].…”

Catalyzing the scale‐up of community‐based primary healthcare in a rural impoverished region of northern Ghana

“…As a component of its initial response to gaps in essential services, GEHIP implemented a system of mortality audits to provide regional health managers with rapid feedback on preventable maternal and neonatal risks (Awoonor-Williams et al, 2015). In response to evidence that asphyxia was a prominent contributor to excess mortality, all frontline workers were trained in resuscitation management, referral services and essential emergency management.…”

Measuring delay in high-risk obstetric referrals in Accra, Ghana: How long does it really take?

“…In the current study, we found that 81.9% of referred patients arrived by means of public transport. This has been corroborated by others [2,3,6,16,29,30]. Even when ambulances are utilized, delay is often encountered as patients may need wait for ambulances to arrive from other locations or are asked to provide funds to fuel the vehicle [2, 4-6, 24, 29].…”

“…It is important to identify and categorize referral related barriers, whether considered Phase II or Phase III delay, in the provision of timely CEmOC in low resource countries and this topic remains vastly under-researched [2,6,26,27]. A strong referral system is characterized by communication and coordination along the referral pathway, with tailored referral protocols, patient support, protection against costs, and e cient transportation [2,6,16]. Having an effective and e cient referral system can reduce stillbirth, neonatal and maternal deaths [9,31].…”