Lessons Learned from Ghana's Project Fives Alive!

A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives


Sodzi-Tettey S, Twum-Danso NAY, Mobisson-Etuk N, Macy LH, Roessner J, Barker PM. Lessons Learned from Ghana’s Project Fives Alive! A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2015.

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How Do You Set Up a Large-Scale Improvement Project for Success?

After seven years of rapidly and successfully scaling up high-impact maternal and child health interventions across Ghana using a QI approach, the lessons learned from Project Fives Alive! are finally being brought into the spotlight.

A partnership between the National Catholic Health Service of Ghana and the Institute for Healthcare Improvement in the United States, Project Fives Alive! stands out as a large-scale improvement initiative that harnessed the creativity of frontline workers and managers, relentlessly promoted use of local data by QI teams, and adapted its design and implementation to reflect rich and real health system lessons.

A snapshot of results as of November 2014:

  • 31% reduction in under-5 mortality in 134 hospitals
  • 37% reduction in post-neonatal infant mortality in 134 hospitals
  • 35% reduction in under-5 malaria case fatality in 134 hospitals

Key Success Factors, Challenges, and Recommendations

This new guide harvests lessons learned from Project Fives Alive! about project design, day-to-day project management, building quality improvement capability, managing complex partner relationships, providing technically effective and inspiring leadership, deploying a core set of balanced metrics, and harnessing the power of effective communication.

Developed through extensive key informant interviews, the guide serves as a practical roadmap for those also striving to design and execute improvement initiatives to achieve results at scale.

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