Abstract
BackgroundReferral 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.MethodsWe analyzed longitudinal time series data from routine records of the call center over the first 33 months of its operation in Excel.ResultsDuring 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.ConclusionsThe 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.
Highlights
Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care
The call center is a potentially useful and viable M-Health intervention to support referral and clinical decision making in the low- and middleincome countries (LMIC) context of this study
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
Summary
Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care. Thaddeus and Maine after an exhaustive review of literature identified that delays in identifying and reaching the appropriate facility (type II delays) and the delays in receiving of quality care once the woman reaches the facility (type III delays) were major contributing causes of maternal morbidity and mortality in low and middle income countries [4]. Studies before and after the introduction of the policy identified the quality of care in health facilities, including provider decision making on management choices and poor referral practices in health facilities as a major contributor to the poor maternal and newborn outcomes [5, 6]
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