Impact evaluation of a quality improvement intervention on maternal and child health outcomes in Northern Ghana: early assessment of a national scale-up project

Int J Qual Health Care. 2013 Oct;25(5):477-87. doi: 10.1093/intqhc/mzt054. Epub 2013 Aug 7.


Objective: To evaluate the influence of the early phase of Project Fives Alive!, a national child survival improvement project, on key maternal and child health outcomes.

Design: The evaluation used multivariable interrupted time series analyses to determine whether change categories tested were associated with improvements in the outcomes of interest.

Participants: The evaluation used program and outcome data from interventions focused on health-care staff in 27 facilities.

Setting: Northern Ghana.

Intervention: The project uses a quality improvement (QI) approach whereby process failures are identified by health staff and process changes are tested in the health facilities and corresponding communities to address those failures.

Main outcome measures: The maternal health outcomes were early antenatal care attendance and skilled delivery, and the child health outcomes were underweight infants attending child wellness clinics, facility-level neonatal mortality and facility-level infant mortality.

Results: Postnatal care changes for the first 1-2 days of life (β= 0.10, P = 0.07) and the first 6-7 days of life (β = 0.10, P = 0.07) were associated with a higher rate of visits by underweight infants to child wellness clinics. There was an association between the early pregnancy identification change category with increased skilled delivery (β = 1.36 P = 0.07). In addition, a greater number of change categories tested was associated with increased skilled delivery (β = 0.05, P = 0.01).

Conclusion: The QI approach of testing and implementing simple and low cost locally inspired changes has the potential to lead to improved health outcomes at scale both in Ghana and other low- and middle-income countries.

Keywords: Ghana; impact evaluation; maternal and child health; mortality; quality improvement; time series analysis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Health Services / organization & administration*
  • Child Health Services / standards
  • Child Mortality
  • Child Welfare / statistics & numerical data
  • Child, Preschool
  • Female
  • Ghana / epidemiology
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Maternal Health Services / organization & administration
  • Maternal Health Services / standards
  • Postnatal Care / organization & administration
  • Postnatal Care / standards
  • Pregnancy
  • Pregnancy Outcome / epidemiology
  • Program Evaluation
  • Quality Improvement* / organization & administration