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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

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...

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Autores principales: Oduro-Mensah, Ebenezer, Agyepong, Irene Akua, Frimpong, Edith, Zweekhorst, Marjolein, Vanotoo, Linda Amarkai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807452/
https://www.ncbi.nlm.nih.gov/pubmed/33441115
http://dx.doi.org/10.1186/s12884-020-03534-2
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author Oduro-Mensah, Ebenezer
Agyepong, Irene Akua
Frimpong, Edith
Zweekhorst, Marjolein
Vanotoo, Linda Amarkai
author_facet Oduro-Mensah, Ebenezer
Agyepong, Irene Akua
Frimpong, Edith
Zweekhorst, Marjolein
Vanotoo, Linda Amarkai
author_sort Oduro-Mensah, Ebenezer
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-020-03534-2.
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spelling pubmed-78074522021-01-14 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 Oduro-Mensah, Ebenezer Agyepong, Irene Akua Frimpong, Edith Zweekhorst, Marjolein Vanotoo, Linda Amarkai BMC Pregnancy Childbirth Research Article 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12884-020-03534-2. BioMed Central 2021-01-13 /pmc/articles/PMC7807452/ /pubmed/33441115 http://dx.doi.org/10.1186/s12884-020-03534-2 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Oduro-Mensah, Ebenezer
Agyepong, Irene Akua
Frimpong, Edith
Zweekhorst, Marjolein
Vanotoo, Linda Amarkai
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807452/
https://www.ncbi.nlm.nih.gov/pubmed/33441115
http://dx.doi.org/10.1186/s12884-020-03534-2
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