Quality Services for Health (Q4H)

The Challenge

The Government of Ghana has made great strides in strengthening its health system in recent years. Its commitment to achieving universal health coverage is anchored by the National Health Insurance Scheme and Community-Based Health Planning and Services, which is a global model for decentralized health care – strengthening and expanding the delivery of community-level primary and preventative care.

Despite these successes, systemic and behavior challenges persist to improving population health, such as limited harmonization, coordination, and linkages across the health system and its service delivery levels. As a result, health outcomes are trending in the wrong direction, including increasing mortality rates and disparities in access to quality services.

Overview and Objectives

Improving the quality of care requires coordinated, system-wide action with buy-in from key Actors. Through the Q4H Activity in Ghana, URC and its partners and collaborators are integrating our experience in quality improvement (QI), social and behavior change, and gender equity and social inclusion (GESI) to support Ghana’s public and private health system actors to sustainably improve health services quality across Ghana.

Q4H Activity’s objectives include:

• Strengthening national, regional, and district leadership and governance of quality management (QM) structures and processes;
• Instituting processes to empower and capacitate local leaders to identify and address systemic, local QM challenges, including improving the use of data at public and private service delivery points; and
• Strengthening the Community Health Management Committees’ (CHMCs’) capacity to coordinate and promote a culture of quality. CHMCs supervise volunteer health workers and coordinate with health service providers and communities.

We are supporting shared learning and cross-fertilization using behavior-led QI/QM approaches from national to community levels in part by working with the Ghana Ministry of Health’s (MOH) Policy, Planning, Monitoring, and Evaluation Division, the National Quality Strategy Steering Committee, Ghana Health Service (GHS), and other relevant Agencies. We also are supporting the Health Facilities Regulatory Agency to develop tools to monitor and accredit all facility types, both public and private, as a major step to monitor and enforce adherence to quality service delivery.

These efforts include other non-governmental health providers, including the Christian Health Association of Ghana and private self-financing facilities, to support public-private investments and align QM initiatives across the health system.

Achievements

• Developing QI/QM training materials and courses: The Activity collaborated with MOH Agencies, including the GHS and private sector providers to develop harmonized QI/QM training materials and courses, integrated with GESI, for the MOH/GHS to train QM teams (QMTs) and work improvement teams (WITs) across the public health system levels and private sector teams. 
• Improving health workers and facilities’ QI/QM capacity: The Activity has been supporting regions, districts, and health facilities to establish QI and QM structures to empower and capacitate local leaders to identify and address systemic and local QI/QM challenges, such as improving data usage at public and private service delivery points in seven regions and 26 districts. The Activity supported with training and establishing seven regional QMTs, 24 district QMTs, 24 district hospital QMTs, and 72 sub-district QMTs and WITs across 18 district hospitals and 66 health centers in 2022. The WITs are currently implementing various data-driven QI projects to address service delivery gaps in their respective health facilities.

The all-Ghanaian Q4H Activity project team builds on the foundation of URC’s previous successful implementation in Ghana, including through the Systems for Health (S4H) and Promoting Malaria Prevention and Treatment (ProMPT) projects.