Health system strengthening to reduce maternal and perinatal deaths in Central Region of Ghana – project approach

Institutional maternal and perinatal outcomes are highly specific to local contextualized conditions and are suited to inform local policy. As institutional delivery increases, maternal health events are more likely to occur in facilities than at home. This was a before-after impact evaluation study through the implementation of a 3-year quality improvement project undertaken in Central Region. The goal was to reduce institutional maternal mortality ratio and perinatal mortality rate over a 3-year period from 2021 to 2023 with 2020 as a baseline year. Baseline assessment was conducted by reviewing 2020 maternal death audit reports to identify key challenges associated with maternal deaths. Interventions were drawn to address identified challenges by key stakeholders. Sensitization meetings were held with stakeholders, health managers and health staff to discuss the interventions and solicited their support. Interventions implemented were life-saving skills and safe motherhood trainings for health staff across the region, introduction of maternal death tracker to improve surveillance on maternal death, clinical supervision of health staff at the peripheral level by specialist through telemedicine using WhatsApp platforms from 2021 to 2023. Baseline indicators were collected from the District Health Information Management System-2 (DHIM2) in 2020. The outcome indicators were improved family planning coverages, increased skilled delivery rates and reduction in maternal mortality ratio and perinatal mortality rates. Process indicators were proportion of practicing midwives and clinicians trained in life saving skills, number of health centers conducting basic emergency obstetric care signal functions, percentage of audited maternal deaths entered DHIMS2. Over the course of the project, 4,800 health staff were trained, skilled birth rate improved from 61.6 to 63.9%, family planning acceptor rate from 28.5 to 45.1% and reported maternal deaths audited improved from 78.7 to 100%. The implementation of institutional audit recommendations also improved from 20 to 72%. Institutional maternal mortality ratio declined by 25.3% and neonatal deaths by 45.2%. Quality improvement methods using the project approach to strengthen maternal health services can lead to improve mother and baby health outcomes. This approach when scaled up nationally may help increase the chances of meeting the sustainable development goal three, I recommend the implementation of the interventions to policymakers such as the Ministry of Health to support in reducing institutional maternal and perinatal mortalities.