PFA makes significant strides

The Project Five Alive!(PFA), a seven-year initiative to assist ongoing efforts to reduce death in children below ages five in Ghana, using quality improvement methods in health system, has recorded remarkable gains in saving many lives of infants.

At the closing ceremony of the Project in Accra on Monday, Dr. Sodzi Sodzi-Tettey, Senior Technical Director of the Project, sharing some reflections on the impact of the initiative, stated that as of April 2015, the under-five mortality rates in 140 health facilities the project worked with nationally had reduced by 32 percent.

He expressed hope that Quality Improvement (QI) methods used during the project will transcend every facet of national health delivery, noting that a National Quality Forum will be a stepping stone to further ensure QI works in Ghana.

To intensify the QI practice in health facilities, Dr. Sodzi-Tettey called on authorities to redefine the roles of the 400 Improvement Coaches the PFA trained, to help ensure the adherence of quality improvement measures to improve effective health delivery to patients.

He said as the influence of patient communities grows, it must be accounted for in programming, adding that effective community engagement can help solve small problems associated with projects.

“Quality Improvement alone was not enough, but quality planning, quality control and quality improvement integration is key” to ensure success of health interventions in the country, Dr. Sodzi-Tettey observed.         

Project Fives Alive! is a partnership between the Institute for Healthcare Improvement (IHI) and the National Catholic Health Service (NCHS) to reduce morbidity and mortality in children less than five years old (Under-5) and also improve faulty referral processes in maternal and newborn care in Ghana.

Project Fives Alive! officially launched on July 8, 2008, in three districts in northern Ghana, was a seven year project funded by the Bill & Melinda Gates Foundation, and the collaborative work between IHI, NCHS, and the Ghana Health Service to achieve the objectives of the project which was implemented in four consecutive waves (phases) in all regions of Ghana.

Mr. George A. Adjei, Director of NCHS, in a presentation, described the PFA project as special and complex, in terms of its design, duration and strategy, which started in three selected sub-districts, extending to districts and then to all regions of Ghana.

He summarized the experience of the project as challenging, gratifying and inspiring, stating that the results at the end, the project contributed immensely to reducing under-five mortality in Ghana.

The Director said the project was inspirational in that it has taught the personnel skills of improvement science, adding that the NCHS has adopted it as a business strategy, which has been applied in the NHIS billing and claims management and to improve on the pass rate of students in the Midwifery training colleges under NHCS, with remarkable results.

He said the project was also inspiring because it has heightened appreciation of data to tract performance for managers at all level, as well as re-awakened the “do-it-yourself” spirit among managers that has enable them not to wait to be told what needed to be done to fix system bottlenecks.          

Touching on the challenges of the project, Mr. Adjei, noted that the national focus of PFA, and managing staff and resources at different sites from Accra, Tamale and later in Kumasi offices was a challenge; adding it challenging “working with partners from different cultural, ethical and national orientations which sometimes brought little tensions from time to time.” 

He thanked the partners and all past and present staff, who worked and ensured the success of the project, stressing that though the project had closed, it bequeathed to individuals, service providers and country the ideology of Quality Improvement, which gives a new impetus to apply Continuous Quality Improvement methods in all facets of life.

“What we require is the discipline to continue using data to guide our decisions and interventions,” he added.

Most Rev. Joseph Afrifah-Agyekum, Bishop of Koforidua and Bishop responsible for Health, who Co-chaired the function, commended the staff and the partners in their commitment that contributed to the success of the project for the past years.

He noted that though the project was ending with poignant lessons and the impact made in saving lives, its continuity was paramount to ensure quality improvement in healthcare delivery to patients.

Prof. Pierre Barker, Senior Vice President, Institute for Healthcare Improvement, who co-chaired the function, reminiscing exciting experiences during visits to some project sites, thanked all partners and staff for their tireless efforts in making the project a success.

“The project was largely successful with a combination of hard work and faith in God,” he added.     

Dr. Nana Twum-Danso, Former Director of the Project in a brief remark recounted the cordiality that existed among the staff, adding that the project was the most challenging in her professional experience, but added it was the most rewarding.                

She commended the wonderful collaboration that existed between partners on the project; the stimulating mental exercise that brought to bear the wealth of creativity among staff and also the effective team spirit fostered, which helped them to adopt new ideas to adjust designs that ensured the overall success of PFA. 

Some staffs who shared their experiences touched on the challenging lessons PFA taught them and the inspiring opportunity the project gave them to contribute to efforts at saving lives of infants.

Certificates and Souvenirs were presented to staff in appreciation for their hard work, dedication and commitment to the success of Project Fives Alive.     

By applying QI methods, Project Fives Alive! sought to assist and accelerate Ghana’s faith-based and public health services to reach the country’s fourth Millennium Development Goal (MDG) of reducing mortality in children under-5 from an estimated 110 per 1000 live births to less than 40 per 1000 live births (66% decrease) by 2015

Secondly, the core QI framework upon which the project was designed was the Model for Improvement, which enabled the project staff and the local QI teams with whom they work to set aims, identify process failures and develop, test and assess whether changes were leading to improvements.

The Improvement Collaborative Network, which accelerates peer-to-peer learning and improvement on a large scale, was an integral part of the project’s design. Thus in every four to six months, the local QI teams convene at a Learning Session to acquire QI knowledge and skills, and to share their QI experiences and learn from their peers’ successes and challenges. They therefore apply what they have learned during the intervening Activity Periods, with support from their district managers and the project staff who visit them monthly to assist with development and testing of change ideas, and implementation and sustainability of successful changes.