Quality Services for Health (Q4H)

The Challenge

The Government of Ghana has made great strides in strengthening its health system in recent years. Its commitment to achieving universal health coverage is anchored by the National Health Insurance Scheme and Community-Based Health Planning and Services, which is a global model for decentralized health care – strengthening and expanding the delivery of community-level primary and preventative care.

Despite these successes, systemic and behavior challenges persist to improving population health, such as limited harmonization, coordination, and linkages across the health system and its service delivery levels. As a result, health outcomes are trending in the wrong direction, including increasing mortality rates and disparities in access to quality services.

Overview and Objectives

Improving the quality of care requires coordinated, system-wide action with buy-in from key actors. Through the Q4H Activity in Ghana, URC and its partners and collaborators are integrating experience in quality improvement (QI), social and behavior change, and gender equity and social inclusion (GESI) to support Ghana’s public and private health system actors to sustainably improve health services quality across Ghana.

Q4H Activity’s objectives include:

• Strengthening national, regional, and district leadership and governance of quality management (QM) structures and processes;
• Instituting processes to empower and capacitate local leaders to identify and address systemic, local QM challenges, including improving the use of data at public and private service delivery points; and
• Strengthening the Community Health Management Committees’ (CHMCs’) capacity to coordinate and promote a culture of quality. CHMCs supervise volunteer health workers and coordinate with health service providers and communities.

We are supporting shared learning and cross-fertilization using behavior-led QI/QM approaches from national to community levels in part by working with the Ghana Ministry of Health’s (MOH) Policy, Planning, Monitoring, and Evaluation Division, the National Quality Strategy Steering Committee, Ghana Health Service (GHS), and other relevant Agencies. We also are supporting the Health Facilities Regulatory Agency to develop tools to monitor and accredit all facility types, both public and private, as a major step to monitor and enforce adherence to quality service delivery.

These efforts include other non-governmental health providers, including the Christian Health Association of Ghana and private self-financing facilities, to support public-private investments and align QM initiatives across the health system.

Achievements

• Supported the Ministry of Health (MOH) to develop a new National Healthcare Quality Strategy (NHGS 2024-2030) to guide quality management governance, processes and activities in the country.
  
• Worked with the MOH to strengthen national leadership and governance of quality management, resulting in 96% of MOH agencies (27/28) having functional quality management teams, up from a baseline of 68% in 2021.
  
• Strengthened the National Quality Technical Committee (NQTC) of the MOH to coordinate quality management activities of the MOH agencies through supportive supervision and quarterly NQTC meetings.
  
• Trained 411 Community Health Management Committees (CHMCs) across 25 districts on the Ghana Community Scorecard, development of community health action plans, the Ghana Patient’s Charter, and CHMC roles and responsibilities in Community-based Health Planning and Services implementation.

The Q4H Activity achieved the following between FY22 (Oct 2021-Sep 2022) and FY24 (Oct 2023-Jun 2024):

• 41% increase in uploading of community scorecard scores onto DHIMS 2 in 25 districts across 7 regions (from 38% to 66%)
• 18% increase in percentage of functional Community-based Health Planning and Services Zones with Community Health Action Plan in 25 districts across 7 regions (from 81% to 98%)
• 44.1% decrease in stillbirth rate in ten high burden district hospitals in six regions (from 15/1000 to 8.4/1000 births)
• 64% reduction in institutional neonatal mortality rate in eleven district hospitals across five regions (from 5.4/1000 to 1.9/1000 live births)
• 24% increase in intermittent preventive treatment of malaria during pregnancy (IPTp) 3 coverage in 11 health facilities across 9 districts in six regions (from 64.7% to 85.1%)
• 44% reduction in the prevalence of anemia among pregnant women at 36 weeks in seven health facilities across five districts in four regions (from 59% to 33%)
• 49% reduction in institutional maternal mortality ratio in nine district hospitals across five regions (from 199/100,000 to 61/100,000 live births)