Dominic Dormenyo Gadeka, PhD, MPH
DORMENYO GADEKA
Nominated From: University
Research Site: University of Ghana
Research Area: Health Systems and Policy
Primary Mentor: Name
Research Project
Strengthening Patient Referral Pathways for Basic Emergency Obstetrics and Newborn Care (BEmONC) in Ghana: A mixed-methods comparative evaluation of Referral Networks in the context of Networks of Practice implementation
The Government of Ghana is rolling out a nationwide Free Primary Healthcare (Free PHC) program to expand access to essential services and accelerate progress toward Universal Health Coverage (UHC) by 2030. Primary Health Care Networks (PHCNs) are being considered as a central delivery mechanism to organize services through shared patient-centered pathways across community, primary, and district levels. The Network of Practice (NoP) initiative, a type of PHCN, offers early implementation-level insights of networked primary care in Ghana, but the mechanisms of what has worked, what has not, and why across different contexts and settings remain insufficiently understood. This study focuses on Basic Emergency Obstetric and Neonatal Care (BEmONC) referral pathways, which are critical to reducing maternal, neonatal, and under-five mortality but remain constrained by weak system linkages. This adopts a theory-driven mixed-method comparative evaluation of NoP and non-NoP districts to identify context, mechanism and outcome configurations shaping BEmONC performance. It will involve qualitative interviews, social network analysis, interrupted time series, and difference-in-differences approaches. Findings will inform strategies to strengthen BEmONC referral pathways, ultimately enhancing equitable and sustainable delivery of Free PHC and improving obstetric and neonatal outcomes in Ghana.
Research Significance
This study addresses a significant gap in Ghana’s health system and aligns with the country’s primary care policy. Efforts to reduce neonatal mortality to 12 per 1000 live births and under-5 mortality to 25 per 1000 live births continue to face challenges. Currently, only 66% of facilities offer BEmONC, and only 15% provide all 7 BEmONC signal functions, which include parental administration of antibiotics, oxytocins, and anticonvulsants, assisted vaginal delivery, manual removal of the placenta, manual removal of retained products of conception, and neonatal resuscitation with bag and mask. An effective referral system is crucial for improving access to and quality of care, thereby addressing maternal and newborn care outcomes. The impact of this study will be through informing current Free PHC. The data generated will guide the implementation of referral pathways for BEmONC within the context of the Free PHC, thereby strengthening the referral pathways and improving obstetric and neonatal outcomes in Ghana. The global call to end preventable deaths of newborns and children under 5 years underscores the study’s significance to the international community
Publications
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