Developing Acute Care and Referral Systems (ACERS)
Name: Serwah Afranie
School: Mailman School of Public Health, Class of 2022
Mentor: Rachel Moresky, MD, MPH, Koku Awoonor-Williams, MD, PhD, MPH & Andrews Ayim, MBChB, MBA, MPH (Ghana Health Service)
Name: Amir Hassan
School: Vagelos College of Physicians and Surgeons, Class of 2024, Varmus Global Scholar 2021
Mentor: Rachel Moresky, MD, MPH, Koku Awoonor-Williams, MD, PhD, MPH & Andrews Ayim, MBChB, MBA, MPH (Ghana Health Service)
Name: Karl Reis
School: Vagelos College of Physicians and Surgeons, Class of 2024, Varmus Global Scholar 2021
Mentor: Rachel Moresky, MD, MPH, Koku Awoonor-Williams, MD, PhD, MPH & Andrews Ayim, MBChB, MBA, MPH (Ghana Health Service)
Name: Kelvin Tamakloe, MBChB
School: Mailman School of Public Health, Class of 2022
Mentor: Rachel Moresky, MD, MPH, Koku Awoonor-Williams, MD, PhD, MPH & Andrews Ayim, MBChB, MBA, MPH (Ghana Health Service)
Name: Wisdom Elorm Yevudza
School: Vagelos College of Physicians and Surgeons, Class of 2024, Varmus Global Scholar 2021
Mentor: Rachel Moresky, MD, MPH, Koku Awoonor-Williams, MD, PhD, MPH & Andrews Ayim, MBChB, MBA, MPH (Ghana Health Service)
Abstract
While Ghana has a well-organized healthcare system, there are opportunities to strengthen the continuum of care process throughout the emergency obstetric and newborn care (EmONC) system to further decrease maternal and neonatal morbidity and mortality. To address these obstacles in the Northern and Oti regions of Ghana, the Developing Acute Care and Emergency Referral System (ACERS) project seeks to strengthen the EmONC system through implementation research and cascading capacity-building. The primary objective of this practicum was to determine current health system functioning, and define facilitators and barriers to ACERS interventions. A series of mixed methods baseline surveys were conducted to inform implementation of ACERS interventions, and to serve as a comparison to endline data post-ACERS interventions: women, health worker, facility, and referral surveys. The study identified gaps in health-seeking behavior of women in two rural districts of Ghana, compounded by challenges with access to appropriate health facilities. Gaps with referral protocols and working transport systems for referrals were elucidated. Health workers reported multiple barriers to emergency referral, including cost of fuel, road conditions, and gaps in phone networks. These barriers differed between districts. EmONC signal function performance assessment shows only municipal hospitals relative to sub-hospital facilities constantly fulfilled all signal functions relevant to their EmONC status. Findings suggest opportunities for improving women’s health seeking behavior and referrals. Furthermore, avenues exist to enhance EmONC by supporting facilities’ capacity to perform signal functions corresponding to their rung on the ladder of care.