Implementation of a referral and expert advice call Center for Maternal and Newborn Care in the resource constrained health system context of the Greater Accra region of Ghana

Abstract

Background Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care. This paper presents analysis of the use of a pilot referral and decision making support call center for mothers and newborns in the Greater Accra region of Ghana, and challenges encountered in implementing such an intervention. Methods We analyzed longitudinal time series data from routine records of the call center over the first 33 months of its operation in Excel. Results During the first seventeen months of operation, the Information Communication Technology (ICT) platform was provided by the private telecommunication network MTN. The focus of the referral system was on maternal and newborn care. In this first phase, a total of 372 calls were handled by the center. 93% of the calls were requests for referral assistance (87% obstetric and 6% neonatal). The most frequent clinical reasons for maternal referral were prolonged labor (25%), hypertensive diseases in pregnancy (17%) and post-partum hemorrhage (7%). Birth asphyxia (58%) was the most common reason for neonatal referral. Inadequate bed space in referral facilities resulted in only 81% of referrals securing beds. The national ambulance service was able to handle only 61% of the requests for assistance with transportation because of its resource challenges. Resources could only be mobilized for the recurrent cost of running the center for 12 h (8.00 pm – 8.00 am) daily. During the second phase of the intervention we switched the use of the ICT platform to a free government platform operated by the National Security. In the next sixteen-month period when the focus was expanded to include all clinical cases, 390 calls were received with 51% being for medical emergency referrals and 30% for obstetrics and gynaecology emergencies. Request for bed space was honoured in 69% of cases. Conclusions The call center is a potentially useful and viable M-Health intervention to support referral and clinical decision making in the LMIC context of this study. However, health systems challenges such inadequacy of human resources, unavailability of referral beds, poor health infrastructure, lack of recurrent financing and emergency transportation need to be addressed for optimal functioning.

Challenges Affecting Health Referral Systems in Low-And Middle-Income Countries: A Systematic Literature Review

“…Patients do not receive preferential treatment as expected and others fail to take up the referral. The existence of limited human resources among health care providers affects the quality of health care provided (Oduro-mensah et al, 2021). This affects the quality of services offered due to the inadequate staff.…”

Web-Based Health Monitoring System and Textual Mining

“…The call center was subsequently set up with a local private telecom partnership. At the early days of call center service, the objectives for the design and implementation of the call center intervention were to improve maternal and neonatal health outcomes in the Greater Accra region by: (1) Facilitating the referral processes for maternal and newborn emergencies primarily (2) Providing reliable expert advice to frontline healthcare providers, (3) Identifying and assuring sustainable and affordable local financing for the recurrent maintenance costs of the intervention [8] [23].…”

A tale of 22 cities: utilisation patterns and content of maternal care in large African cities

“… 27 36 37 Such an understanding can help in planning and targeting models of service delivery in these settings 38 and when introducing innovation in service delivery within cities. 39 …”