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Ghana's achievement can serve as an example for other health systems working to adopt a quality improvement strategy with the buy-in of many stakeholders.
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Ghana Launches a Five-Year Quality Strategy

By Sodzi Sodzi-Tettey | Thursday, December 22, 2016
Ghana’s Health Ministry has launched a five-year National Healthcare Quality Strategy that envisions a health system that places the client at the center of health care and ensures continuously improved measurable health outcomes.

Developed over eight months through a deep consultative process, the strategy incorporates views from health professionals at various levels of the health system, senior management, patients, community groups, regulators, health insurance managers, teaching hospitals, and health training institutions. 

Ultimately, the strategy makes concrete proposals for improving the quality and reliability of care through carefully coordinated activities in quality planning, quality control, and quality improvement. It lauds previous efforts to improve the quality of care and leverages these efforts by providing a platform for better coordination and implementation of the Patient’s Charter, code of ethics and discipline, patient safety policies, health management information systems, and all such previous endeavours. 

This National Healthcare Quality Strategy aims to coordinate the system of health and health care quality at all levels of the health system, across both the public and private sectors, and all areas of health – with a particular focus on the following priority health areas:

  • Maternal health
  • Child health, with a special focus on newborns, infants, children under five, and preventing and treating malaria
  • Epidemic-prone diseases such as cerebrospinal meningitis and cholera
  • Non-communicable diseases, such as hypertension, diabetes, mental health, and geriatric care

Strategic Objectives: Defining Our Aim

The strategy has three broad goals with eight strategic objectives. The three goals are continuous improvement in health outcomes in the above-named priority areas, improved coordination among all agencies of the health system at all levels, including better use of data for decision making, and finally, improved client experience by being responsive to the health needs and aspirations of the patient and the community.

These goals will be achieved through the following strategic objectives:

  • Improved capacity of relevant health workers to manage identified priority health interventions
  • Active promotion of a quality culture and accountability for quality in all health workers and sector agencies
  • Effective leadership, and governance for quality at all levels of the health system
  • Strengthen coordination among all health sector agencies
  • Standardized collection of data and improved analysis and use of data for decision making at all levels
  • Resourcing regulatory agencies, especially the Health Facilities Regulatory Authority to roll out a nationwide accreditation process with clear links to facility-based quality management teams for ongoing improvement action
  • Improved client safety and satisfaction
  • Developing a culture of “joy at work,” including but not limited to adequate financing, logistics provision, recognition, and reward

The Ministry of Health believes that these objectives will allow the Ghanaian health sector to create the context for health providers to treat clients with dignity and respect, deliver high quality care, and be motivated to continuously improve health outcomes.

In addition, the ministry intends to rigorously assert its leadership and coordination over its agencies to ensure that no effort is spared to mainstream quality in all activities of the health sector. More specifically, this means stronger leadership and coordination from the ministry of all its agencies to address identified gaps inhibiting improved patient care and outcomes. It also means more partnership directly with patients themselves, to understand what truly matters most to them.

The ministry will work closely with all its agencies and patient groups through the newly formed National Quality Steering Committee to oversee successful and robust implementation of the strategy.

Hope and a Plan

The National Quality Strategy Steering Committee gives cause for hope, because it harnesses rich talent and experience from a cross-section of agencies, including the Ghana Health Service, teaching hospitals, Christian Health Association of Ghana, regulatory authorities, National Health Insurance Authority, health training institutions, and the private sector. The Committee also includes experts from the National Ambulance Service, Blood Transfusion Services, procurement and supply, and Mental Health Authority. Most exciting is the inclusion of a patient representative. The Steering Committee expects to harness the expertise of partners in the areas of quality improvement, infection prevention control, patient safety, data analysis, and other fields.

Significantly, the National Quality Strategy Steering Committee is only one arm of a broader Quality Governance Structure which integrates quality across the public health and clinical care domains at the regional, district, and the facility levels. Within various health facilities across the country, the strategy envisages the formation of multidisciplinary quality management teams to tackle clearly identified gaps in processes and health outcomes in the priority areas with the support of their management.

The strategy is delivered with an accompanying Coordination and Accountability Framework, which outlines an action plan for coordination of implementation, assigns implementation roles to health sector agencies, and discusses possible financing mechanisms. This framework also lists specific activities that need to be executed under the guidance of the National Steering Committee. One of the key activities is a plan to assemble health experts and specialists to define appropriate standards of care for the various levels of the health system, from communities to tertiary hospitals.

The short-term financing proposal is for all health facilities and agencies to contribute to the implementation of this strategy using a proportion of agencies’ returns to the ministry, together with donor support, which is not viewed by the ministry as a sustainable means of funding. In the long term, the strategy plans that facilities and agencies use their internally generated funds to drive these quality improvement initiatives.

Learn more about large-scale improvement in Ghana in the IHI publication, Lessons Learned from Ghana's Project Fives Alive!.

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