Scaling up Ghana's national newborn care initiative: integrating 'helping babies breathe' (HBB), 'essential care for every baby' (ECEB), and newborn 'infection prevention' (IP) trainings

Abstract

Background: Responding to stagnating neonatal mortality rates in Ghana, a five-year collaboration called Making Every Baby Count Initiative (MEBCI) was undertaken to improve the quality of newborn care provided around the time of birth. A multi-pronged approach was used to build health worker (HW) capacity in resuscitation, essential newborn care, and infection prevention using a curriculum built on the American Academy of Pediatric's (AAP) Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) modules with an added section on infection prevention (IP). Methods: MEBCI used a training of trainer's approach to train 3688 health workers from district-level facilities in four regions in Ghana between June 2015 and July 2017. Prior to training, HWs familiarized themselves with the learning materials. Concurrently, MEBCI worked to improve enabling environments that would sustain the increased capacity of trained health workers. Knowledge and skills gained were tested using AAP's Knowledge checklist and validated single-scenario Objective Structured Clinical Examinations (OSCEs) tools. Findings: Majority of HWs trained were midwives (58.8%) and came from district-level hospitals (88.4%). Most HWs passed the HBB OSCE (99.9%, 3436/3440). Age of doctors was negatively associated with HBB scores (r = − 0.16, p = 0.0312). Similarly, older midwives had lower HBB scores (r = − 0.33, p value < 0.001). Initiating ventilation within the Golden Minute was challenging for HWs (78.5% passed) across all regions. Overall, the pass rate for ECEB OSCEs was 99.9% in all regions. Classify newborn for further care and communicate plan to family were frequent challenges observed in Volta Region (69.5% and 72.0% pass rate respectively). HWs less than 40 years of age performed significantly better than health workers older than 40 years (p = 0.023). Age of only paediatricians was positively associated with ECEB scores (r = 0.77, p < 0.001) while age of midwives was negatively associated with ECEB scores (r = − 0.08, p < 0.001).

The role of the public and private health sectors on factors associated with early essential newborn care practices among institutional deliveries in Ghana

“…Firstly, the public sector health facilities has a higher number of skilled health professionals compared to the private sector health facilities [ 27 ], and skilled health professionals are more likely to adhere to good EENC practices [ 28 ]. In addition, in-service trainings on newborn care from the Ministry of Health and its partners have mostly benefited staff from the public sector health facilities [ 21 ]. There is also higher participation in continuous professional development training among staff in the public sector health facilities compared to the private sector health facilities; and knowledge of EENC has been found to be associated with compliance with good EENC practices [ 5 , 16 ].…”

“…Ghana’s Ministry of Health and its partners usually focus on training health staff in public sector health facilities on newborn care. In addition, logistics and support aimed at promoting newborn care have mostly been channeled to the public sector facilities [ 21 ].…”

Challenges Faced by Healthcare Providers in Delivering High-Quality Care to Neonates in Ghana and West Africa

“…[31][32][33][34] The shortage of skilled healthcare professionals further exacerbates this issue, as it hampers the ability to provide timely interventions and specialized treatments. [35][36][37] Furthermore, contextualizing these factors within the Ghanaian healthcare system sheds light on additional gaps in research and theories concerning neonatal care. While there have been efforts made towards improving healthcare services, there remains a lack of comprehensive studies focusing specifically on neonatal care in West Africa.…”

“…[220][221][222][223] The dearth of reliable data on neonatal health outcomes also poses a significant challenge for healthcare providers in Ghana. [224][225][226][227] Without accurate information on morbidity and mortality rates among neonates, it becomes challenging to identify areas that require improvement or evaluate the effectiveness of interventions implemented. Consequently, addressing gaps in data collection systems should be a priority for improving neonatal care delivery.…”

“…Additionally, inadequate training and knowledge among healthcare providers contribute to suboptimal practices in neonatal care. [238][239][240] Many providers lack awareness of evidencebased guidelines and protocols for neonatal care, resulting in variations in practice that may not align with international best practices. [241][242][243][244][245][246] To address these challenges, evidence-based guidelines and protocols can be tailored to the local context of Ghana and West Africa's healthcare system.…”