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.
