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Glob Public Health. 2015 Oct;10(9):1118-33. doi: 10.1080/17441692.2015.1027247. Epub 2015 Apr 1.

Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

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a Regional Health Directorate , Ghana Health Service , Bolgatanga , Upper East Region , Ghana.
b Swiss Tropical and Public Health Institute , Socinstrasse , Basel , Switzerland (associated with University of Basel, Peterplatz, Basel, Switzerland).
c Averting Maternal Death & Disability , Columbia University, Mailman School of Public Health , New York City , NY , USA.
d FHI 360 , Durham , North Carolina , USA.
e Navrongo Health Research Centre , Navrongo , Ghana.
f Regional Hospital of Bolgatanga , Bolgatanga , Ghana.
g War Memorial Hospital , Navrongo , Ghana.


Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.


Ghana; audit; facilitation of referral; maternal and newborn referrals; referral

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