Publication Date: April 2, 2015
Sodzi Sodzi-Tettey, MD, MPH
IHI Director of Project Fives Alive!
IHI Senior Technical Director, Africa Region
Q: What has been your journey to IHI?
On completion of my Housemanship [internship] training in 2004, I worked in St. Anthony’s Hospital in the Ketu North District [Ghana] as a district medical practitioner, where I managed a variety of conditions and also gained treasured practical exposure to the Ghanaian health system at a lower level. From there I pursued my training in public health, and in 2009, I was appointed deputy coordinator of community and institutional care at the National Catholic Health Service (NCHS). I subsequently became coordinator in charge of monitoring and evaluation.
In October 2009, the third wave of Project Fives Alive!, a collaboration between IHI and NCHS aimed at improving the quality and reliability of care in nine prototype hospitals in Ghana, was about to start and I was drafted to join the project team. I consider it my first formal quality improvement [QI] project, and it was a wonderful experience. Over an 18-month period, through the implementation of very simple local solutions, we reduced facility-based deaths in children under five years of age by 17 percent.
Then in November 2011, Nana [Nana Twum-Danso, former Executive Director for IHI’s Africa Operations] moved on to the Gates Foundation, and I joined IHI as the new director of the project.
Q: What is the focus of your work at IHI?
Project Fives Alive! has been my main focus. As of 2011 when I started, the project had moved from three districts to all 38 districts covering the northern part of Ghana. We had seen a number of improvements in processes: in early antenatal care, skilled delivery, and post-natal care, for example. But up to that point, for a variety of reasons we still hadn’t seen reduction in the major outcome, which was under-five mortality. So we changed our strategy, putting more focus on the hospital-based work, expanding on the learning from the nine prototype hospitals.
Today, the picture is much more hopeful. We’re seeing reduction in under-five deaths in two out of the three regions, with a promising drop in mortality for the subgroup of children 12 to 59 months old in the third region.
In the bigger picture, the national scale-up campaign in the remaining seven regions in Ghana has been ongoing for about 16 months. And in the 134 hospitals we’re working in — which represent coverage in over 80 percent of the public sector hospitals in Ghana — we have recorded a 28 percent reduction in facility-based under-five deaths and a 35 percent reduction in children dying from malaria. This is really significant, if you translate it into actual lives saved. So these are pretty exciting times for the project.
We also started a new IHI Breakthrough Series Collaborative in Ghana, where we are bringing community members into the Learning Sessions for the first time to address faulty referral processes that result in adverse outcomes. We have doctors, midwives, and physicians’ assistants sitting around the table with traditional birth attendants, transport managers, youth activists, and local government officials, having conversations about how to provide safer and more reliable care for newborns and women in labor.
Q: What accounts for the impressive progress your teams have made?
A significant factor in the growth of Project Fives Alive! has been the policy impact it has had within the Ghanaian health system. The results have motivated the Ghana Health Service to adapt our post-natal care (PNC) registries and proposed indicators, our referral registries, and protocols for improving the timeliness, completeness, and accuracy of the District Health Information Systems. We have also coauthored a book on quality and patient safety with colleagues in the Ghana Health Service. We are scheduled to end implementation of Project Fives Alive! in December 2015, and it has truly been a good run.
Another major influence on our results has been the strong technical leadership in QI we have enjoyed from IHI since the beginning of the project. I would like to especially acknowledge the technical guidance of Lloyd Provost [IHI Senior Fellow and Improvement Advisor] and Pierre Barker [IHI Senior Vice President], especially in working with us to contextualize our learning in a structured curriculum for the training of more than 350 local Improvement Coaches to sustain the gains of our work.
I would also like to celebrate the overall leadership of Nneka Mobisson-Etuk, IHI’s Executive Director of African Operations. Under her guidance, we have diversified our offerings in QI capability and pushed new frontiers, such as supporting African Ministries of Health in developing National Quality Strategies for the first time.
Personally, I feel honored to see that my own journey in this work mirrors IHI’s African journey — an expansion of learning, connections, and contributions in one country to new engagements today in South Africa, Malawi, Ethiopia, and Nigeria.
With an exploding enthusiasm for QI training across the continent, it is an exciting time to be representing IHI in Africa.
Q: What are some of the challenges you see ahead for your work representing IHI in Africa?
One area is how IHI operationalizes its work in these new places. IHI has a mission of improving health and health care throughout the world through strategic partnerships with various local organizations. In Ghana, that partnership is with the National Catholic Health Service. So what happens when IHI goes into a place where we do not necessarily have such a prototype? How does IHI work within that environment? I think because this challenge is closely linked to IHI’s mission, it will be important to be able to define a process that the organization is comfortable with and that enables ease of technical operations. I also see related challenges as part of IHI’s expansion and continued QI leadership in Africa — technical, logistical, cultural, and resource-related — that will have to be addressed over time.
Another challenge I would point to has to do with sustainability. How do you design a sustainable large-scale project — and do it from the very beginning? What are the aims and strategies, and how do you implement them in a way that adds value on a local level and is sustainable, given unique and varied scenarios, approaches, and understanding?
Q: What are you most excited about in the journey ahead?
Well, that QI actually works — that you can work with teams at various levels to actually identify and solve their own problems. That’s what fascinates me about this whole process, that I can engage a team of people with empowering QI tools and lead them on a journey of discovery that makes them masters of their own fate!
Sometimes it’s difficult to describe the work in a way people can appreciate at the beginning. It’s only after they see the results emerging that you’ll hear, “Wow, I didn’t understand I could look at my own data this way. The results I’m getting are all the motivation I need.” That’s when you know they are infected… in a positive way.