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Accelerating progress towards attainment of MDG 4 and 5 in Ghana through basic health systems function strengthening (Accelerate Project)

Target Country: 

Project Background:

The Accelerate project seeks to promote reduction in maternal and infant mortality by developing and evaluating approaches for accelerated attainment of the millennium development goals (MDG) 4 and 5. The Accelerate project activities are carried out in the Greater Accra region of Ghana and are expected to provide lessons for Ghana as well as other sub-Saharan African countries.

Millennium Development Goal 4 requires a reduction of under-five child mortality rates by 2/3 and MDG 5 requires reduction of maternal mortality rates by 3/4 between 1990 and 2015. Estimates of community based maternal mortality and institutional mortality rates remain very high in Ghana. Development of new and/or improved interventions to accelerate mortality decline are urgently needed. The Accelerate project seeks to develop and evaluate the impact of integrated and interdependent multi-disciplinary interventions on maternal and neonatal survival in Ghana.

The interventions aim at strengthening the basic health system functions of organization and the delivery of essential and quality health services, human resource management, and governance and clinical decision making related to maternal and neonatal health. The interventions are executed in three closely interrelated research sub-projects. PhD researchers in three disciplines, namely: Epidemiology, Medical anthropology, and Health policy and health systems management are trained within the project as part of capacity building for sustainable development. The PhD researchers’ participation in the project is rooted in their institutional context to strengthen health service delivery and academic institutions in Ghana.

Accelerate Project Findings/Achievements:

The Accelerate project is innovative in its integration of parallel interventions at different levels of the health care system from local to district through regional to national level to address the problem of unacceptably high levels of preventable maternal and neonatal deaths. To date, the Accelerate PhD researchers have made some significant findings about progress towards the goals of the project in the three multi-disciplinary areas as follows: 

Health policy and health systems management:

  • Contextual factors such as political ideology, economic crisis, historical events, social unrest, change in government, election year, austerity measures, international agendas and availability of evidence such as maternal and child mortality trends tend to influence national level decision-making on maternal and neonatal health policies. 
  • Maternal health user fee exemption policies, which have evolved in Ghana since independence, have been made by policy actors who are influenced by the contextual factors at the prevailing environment.  These policies ultimately have implications at the districts and sub-district levels.    
  • District health management’s (DHM) decision-making is influenced or limited by decisions made at the central (national) levels.  For instance if district health managers prepare their budgets based on local needs, implementation of the budget is hampered by lack of funds from central government (national level).
  • Management decision-making at health facility level is influenced by the hierarchical “top-down” decision-making processes.  Information comes to the sub-district health managers (SDHM) from the central (national) through the regional, district and then to the sub-district health management team.

Medical anthropology:

  • Frontline health worker motivation is influenced by national policies, organisational management and contextual factors.
  • Perceptions of injustice in organizational relationships and processes affect frontline health worker motivation in Ghana, which often affects maternal and neonatal services. 
  • Power and respect, which is central to provider relationships, tend to influence maternal and neonatal decision-making. 
  • Pregnant women often decide to withhold their personal information from frontline providers of antenatal services because they feel they will be humiliated by the providers.


  • Dwelling in rural area, community poverty level, illiteracy level, safe water coverage and community healthcare access increased the risk of having low birth weight (LBW) infants.  LBW increases the risk for neonatal mortality.
  • Maternal health insurance status (e.g. health user-fee exemption) observed to improve the utilization of antenatal, skilled delivery and postnatal healthcare services
  • Community socio-economic deprivation positively associates with neonatal death regardless of individual characteristics

Presentation at Conferences/Workshops:

  1. The Accelerate PhD researchers participated in poster presentations at the Third Global Symposium on Health Systems Research in Cape Town, South Africa, (30th September - 3rd October 2014).
  2. Accelerate PhD researcher, Matilda Aberese-Ako, presented on “We are intimidated”: Justice and Frontline health worker motivation in maternal and neonatal health care services provision in Ghana” at the Third International Conference of the African Health Economics and Policy. March 11-13, 2014; Nairobi, Kenya.
  3. The medical anthropology PhD researchers presented at a Policy Dialogue Workshop in Accra, Ghana on Client and Health worker level factors influencing quality of care and decision making related to mother and newborn health and implications for policy and practice on maternal and neonatal health (MNH) in Ghana, (22nd July, 2015).

Publications – Selected Accelerate PhD researchers’ publications

Kwakie A, Dijk VH, Agyepong IA (2015). What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana. Health Systems & Reform; 1(2):167–177.

Ebenezer Oduro-Mensah E, Kwamie A, Antwi E, Bamfo SA, Bainson HM, et al. (2013). Care Decision Making of Frontline Providers of Maternal and Newborn Health Services in the Greater Accra Region of Ghana. PLOS One; DOI: 10.1371/journal.pone.0055610

Koduah A, Han van Dijk Hv, Agyepong IA (2015). The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health Research Policy and Systems; 13:27. Doi:10.1186/s12961-015-0016-9

Irene Akua Agyepong IA, Kodua A, Adjei S, Adam T (2012). When solutions of yesterday become problems of today: crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in Ghana. Health Policy & Planning; 27(suppl 4). Doi: 10.1093/heapol/czs083

Aberese-Ako M, Agyepong IA, Gerrits T, Dijk Hv (2015). 'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital. PLOS One; 10(8): e013512. DOI: 10.1371/journal.pone.0135129

Aberese-Ako MA, Dijk, Hv, Gerrits T, Daniel Kojo Arhinful DK, Irene Akua Agyepong IA (2014). ‘Your health our concern, our health whose concern?’: perceptions of injustice in organizational relationships and processes and frontline health worker motivation in Ghana. Health Policy & Planning; 29(suppl 2):15-28. Doi: 10.1093/heapol/czu06

Kayode GA, Ansah E, Agyepong IA, Amoakoh-Coleman M, Grobbee DE, Klipstein-Grobusch K (2014). Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis. BMC Pregnancy and Childbirth, 14:165. Doi:10.1186/1471-2393-14-165

Amoakoh-Coleman M, Ansah E, Agyepong IAGrobbee DE, Klipstein-Grobusch K (2015). Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: a cross-sectional study of population data. BMJ Open; 5:e007810 doi:10.1136/bmjopen-2015-007810

Amoakoh-Coleman M, Kayode GA, Brown-Davies C, Agyepong IA, Grobbee DE, Klipstein-Grobusch K, Ansah E (2015). Completeness and accuracy of data transfer of routine maternal health services data in the greater Accra region. BMC Research Notes; 8:114  doi:10.1186/s13104-015-1058-3





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