Project Fives Alive (PFA!), a five-year initiative to assist ongoing efforts in Ghana to reduce deaths in children below five, using quality improvement methods has achieved 32 per cent reduction in under five mortality.

The PFA!, an initiative of National Catholic Health Service (NCHS) in partnership with the Institute for Healthcare Improvement (IHI), a US-based Health NGO also achieved 53 per cent reduction of post-neonatal infant mortality and 37 per cent reduction in under five malaria case fatality.

Dr Sodzi Sodzi-Tettey, Senior Technical Director of IHI Africa and Director of PFA! who disclosed this at a close up ceremony in Accra, said in 2008 the NCHS and IHI launched the project with financial support from the Bill and Melinda Gates Foundation to support Ghana to achieve the Millennium Development Goal Four, and has since worked in close collaboration with the Ghana Health Service (GHS).

He said nationally and globally the PFA! established itself as a large scale quality improvement project that has continuously adapted its design over seven years to achieve improved outcomes at scale.

He explained that the project had to be extended to seven years instead of the original five years because of the national scale up.

“The project started in 25 sub districts in three districts and at national scale, has been implemented in over 544 sub districts in all the 10 regions.

Within various health centres, district, and regional hospitals, the project has cumulatively formed and worked with over 700 multi-disciplinary quality improvement teams, testing and implementing high impact change to improve the quality and reliability of facility based care processes for children less than five,” he said.

Dr Sodzi-Tettey said the project operated in four distinct phases and phase one happened between July 2008 and September 2009 in three districts in the three regions of the North.

The phase one focused on improving on antenatal, skilled delivery and post-natal care processes and at the end of it, had developed a package of high impact interventions (Change Package) for improving those processes.

Those interventions, he said, were scaled up to 38 districts in phase two which occurred between July 2009 and March 2013. That led to phase three activities to improve the quality and reliability of hospital based processes in nine innovation hospitals selected from the NCHS between October 2009 and June 2011.

“The phase three activities ended in the development of a second hospital change package, which focused on improving early care seeking, promptness of care and adherence to prescribed standards and protocols,” he added.

Dr Sodzi-Tettey noted that those high impact changes were subsequently scaled up to all 32 NCHS hospitals and later to 36 hospitals in the three regions of the North.

He announced that PFA! in August 2012, launched the Referral Sub-Initiative to facilitate development, testing and implementation of innovative ways to address the challenges impeding safe, timely and effective referrals of pregnant women and neonates from communities to health facilities in six innovation districts in the Central and Northern regions.

“The change package developed from this referral work has been integrated into phase four in an augmentation of the phase one change package and is currently being adopted and adapted to the new local context.

“In May 2013 PFA! embarked on a national scale up in its fourth and final phase and the project is operational in 140 district and regional hospitals-covering 80 per cent of public-sector hospitals and 30 per cent of districts in Ghana,” he added.

Dr Linda Van Otoo, Greater Accra Regional Health Director, said PFA! has brought changes to the way healthcare givers work and commended the team for their dedication to the project.

She said data collated by the PFA! was used to test post-natal care policy of the Ghana Health Service and it proved it is feasible to see newborns twice, and that has resulted in drastic reduction in infant mortality across the country.

PFA! has been independently evaluated by the University of North Carolina at Chapel Hill (USA) in collaboration with the Institute for Statistical, Social and Economic Research (ISSER) of the University of Ghana.