We’re building a new UNICEF.org.
As we swap out old for new, pages will be in transition. Thanks for your patience – please keep coming back to see the improvements.

Evaluation database

Evaluation report

2015 Ghana: Formative evaluation of the programme to accelerate efforts to reduce maternal, neonatal and child mortality in the Northern and Upper East regions of Ghana



Author: Timothee Gandaho and Samuel Bosomprah

Executive summary

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System". Within this system, an external independent company reviews and rates all evaluation reports. Please ensure that you check the quality of this evaluation report, whether it is “Outstanding, Best Practice”, “Highly Satisfactory”, “Mostly Satisfactory” or “Unsatisfactory” before using it. You will find the link to the quality rating below, labelled as ‘Part 2’ of the report.

Background:

The death of infants in the first 28 days of life is increasingly becoming a global health concern. This is especially relevant as it undermines the achievement of the millennium development goal: to reduce under-five mortality.

Many countries in the developing world have, over the years, implemented a series of interventions to reduce the burden of under-five mortality. In line with the National Child Health Policy, UNICEF with funding support from the Government of Japan, has been providing technical and financial assistance to GHS at the National level and in a selection of fourteen districts of the Northern and Upper East regions of Ghana since October 2011 in order to implement the project entitled "Accelerating efforts to reduce maternal, neonatal and child mortality in the Northern and Upper East regions of Ghana".

This project was the subject of this evaluation.

Purpose/Objective:

The Specific objectives of this formative evaluation are:

  1. To ascertain the effectiveness of the package of evidence-based maternal, neonatal and child survival interventions with a focus on community-based (Home-based Postnatal) Care (HBPNC) and facility-based integrated Management of new-born and Childhood Illnesses approaches in the selected districts of the Northern and Upper East regions;
  2. To ascertain the project’s contribution to capacity building that is, developing training resources and facility structures to respond to the high levels of new-born morbidity and mortality in the selected districts of the Northern and Upper East regions;
  3. To ascertain the effectiveness of the evidence-based advocacy by the project on the national policy environment on issues related to new-born survival;
  4. To draw lessons on the implementation capacity for the national expansion of the essential new-born care model through home-based early postnatal care.

Methodology:

The formative evaluation employed a mixed method design consisting of qualitative and quantitative components.

The qualitative component consisted of in-depth interviews with 12 key national decision-makers, donor partners, 16 sub-national health authorities, 12 service providers and 2 focus group discussion (FGD) sessions with mothers drawn from the communities in the two project districts.

The quantitative component involved abstraction of neonatal health indicators from the District Health Information Management System (DHIMS 2) and other relevant data sources based on indicators developed from the evaluation questions as well as project-specifics to assess the project’s success and effectiveness. The scope of the formative evaluation covered the areas of implementation of the project in the two regions (Northern and Upper East Region) of Ghana and at the national level.

Findings and Conclusions:

  • The established level-two new-born care units in the district hospitals have contributed, to some extent, to an improved neonatal survival through an improved management of sick new-born babies.
  • The beneficiaries expressed satisfaction with the home-based care for their babies received from the CHOs/CHNs. They also indicated having received basic counselling on health and wellbeing of mothers and babies.
  • Perceptions and reported statements from beneficiaries indicate that the health and wellbeing of babies have improved substantially to their satisfaction. 
  • A review of the project proposal indicated that due considerations were given to changes in the burden of neonatal deaths in the selection of the project regions.
  • The aim of the project to improve neonatal survival is very much aligned with the national child health policy.
  • The project supported the processes leading up to the development and launch of the National new-born Strategy and 2014-2018 Action Plan.
  • The DHMT/DA is supportive to new-born care but is yet to demonstrate ownership to consolidate the achievements and the expansion of the new-born health interventions within available or mobilized resources for the district.
  • Government resources to the sector are limited and remain basic for the regions where the health services depend on internally generated funds – mainly from the national health insurance scheme. Unfortunately, the delay in payment by the insurance scheme is further threatening service provision.
  • Service providers admit that despite the success of the project, there exist some bottlenecks, which need to be addressed before scaling-up the essential new-born care model through home-based early postnatal care.

Recommendations:

  • The Government of Ghana should commit enough resources to operationalize the National Newborn Strategy and Action Plan.
  • The MoH/GHS should ensure that every district hospital has a Newborn Care Unit for secondary (level 2) care. All regional and teaching hospitals should have Newborn Intensive care Units (NICU) for tertiary (level 3) care. Health Centers and Polyclinics where delivery is conducted should be provided with Basic Emergency Obstetric and Newborn Care (BEmONC) including Newborn Care Corners (NCC).
  • The GHS/MoH should establish resource centres in Regional and Teaching Hospitals along with NCU, to the extent possible using existing structures, to facilitate on-the-job training for newborn care.
  • The GHS should scale-up the home-based postnatal newborn care model to all districts in the regions and to other regions.
  • The MoH should review the curriculum of the Midwifery and Community Health Training Schools to include issues on newborn care or update and strengthen any existing ones.
  • The District Directors should collaborate with the District Assemblies (DA) to ensure that newborn care issues become a standard agenda on district quarterly review meetings.
  • There should be an external and internal newborn care quality audit system.
  • National and subnational levels should support effective documentation, communication and advocacy activities for newborn care.
  • National and subnational levels should support secondary data analysis to identify barriers to newborn care and address them and use operational research results to put more evidence on the table in order to support the mobilization of funds and advocacy for newborn care.


Full report in PDF

PDF files require Acrobat Reader.


 

 

Report information

Year:
2015

Country:
Ghana

Region:
WCARO

Theme:
Health

Type:
Evaluation

Partners:
Ghana Health Service, Government of Japan

Language:
English

 

New enhanced search