Ghana total systems approach

Mothers waiting for antenatal care at Ridge Regional Hospital in Accra, Ghana.  Photo provided by Rohit Ramaswamy

Mothers waiting for antenatal care at Ridge Regional Hospital in Accra, Ghana. Photo provided by Rohit Ramaswamy

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Improving outcomes for high risk women and babies in Ghana: A total systems approach

GGG_ghana_flagThe project is a five-year effort to halve the number of maternal and neonatal deaths at several regional hospitals in Ghana and to establish an obstetric Center of Excellence at Ridge Regional Hospital, which serves the Greater Accra region.


The obstetric and neonatal departments of regional hospitals in Ghana are the facilities of last resort for mothers with serious illness and pregnancy-related complications. More than in other hospitals, mothers at regional hospitals require a unique mix of clinical, operational, and leadership excellence to ensure that the right decisions are made, the right expertise is available and the right resources and supplies are at hand. This requires an approach that simultaneously develops capacity in all aspects of the system that provides care to pregnant mothers and babies. Read More

The approach consists of identifying the key drivers of adverse maternal and neonatal outcomes using mortality audit data, clinical observations, operational measurements of time for key procedures and collaborative discussions with hospital staff. Experiential workshops for doctors and nurses are created to address these drivers. There are several vertical programs (i.e. at department level) addressing various components of the birth process, such as triage, labor and delivery or NICU. Each of these programs teach skills that are not acquired in medical or nursing school, and emphasize accountability, decision making, problem solving and quality improvement in addition to the specific clinical skills needed to take care of sick women. In addition, there are two horizontal programs (i.e. cross departmental) focusing on leadership and quality improvement. These programs are designed to build foundational capacity that cuts across departmental boundaries.

The leadership development model “seeds” the organization with selected staff members who function as coaches and mentors to their peers and subordinates. Leaders of all departments associated with obstetrics and neonatology are part of a “perinatal leadership forum” responsible for maternal and neonatal outcomes in the facility. The forum selects “leadership ambassadors”, “clinical champions” and “quality improvement leaders” who receive additional coaching to be drivers of clinical performance, process excellence and leadership behaviors in the facility.

The staff members designated to these roles serve as catalysts for change within each facility. They lead continuous quality improvement projects at the departmental and facility level to address the linked drivers of maternal and neonatal mortality. Indicators reflecting the clinical, operational and leadership drivers affecting the health of mothers and babies are regularly monitored to identify drops in performance and opportunities for improvement.

Project Team

  • Rohit Ramaswamy (Principal Investigator)
  • Dr. Medge Owen, Wake Forest University
  • Dr. Yemi Olufolabi, Duke University
  • Sarah Iracane and partners from institutions in Canada and the U.K.


Sponsored by: Children’s Investment Fund Foundation

Total funding: $2,266,425


  • Ridge Hospital, Accra, Ghana

In The News

Agent of Change 5 from Kathi Barnhill on Vimeo.

Password: Ghana