BACKGROUND: Poor quality health services have been identified as a threat to global health security. In 2018, the World Health Organization (WHO) and others recommended that countries develop national quality policies and strategies (NQPS) to address this issue. Multi-level, practice-based evidence on NQPS implementation is, however, limited, especially in Sub-Saharan Africa. A mixed methods NQPS study was conducted to systematically (1) identify the institutional barriers and facilitators to implementation, (2) examine the process of implementation, including factors affecting adoption at the national, regional, and hospital levels, and (3) examine the effect of implementation on hospital quality of care in Ghana.
METHODS: The study design was informed by the RE-AIM QuEST framework. Data were collected through a survey (n=36) and in-depth interviews (n=56) with implementation leaders at the national, regional, and hospital levels. Hospital quality of care data were obtained from a national database. Data were analyzed using thematic and time series analysis. Emerging themes on barriers and facilitators were further categorized using the i-PARIHS framework.
RESULTS: Key facilitators included support from donor partners and individual commitment to health quality. Facilitators were overshadowed by several barriers. Notable barriers emerged in these areas at all levels: funding, governance, the national quality culture and history, policy design, dissemination, monitoring, and evaluation. Moral distress and production pressures were among some of the unique barriers at the hospital level. Regulatory requirements strongly influenced the adoption of the NQPS. Lack of dedicated implementation funding and limited implementer knowledge discouraged adoption. Hospitals “implementing” aspects of the NQPS performed better on quality-of-care indicators than those “not implementing” it. However, this difference cannot be attributed to the NQPS with certainty as the policy was yet to be fully disseminated to the hospital level. Most hospital implementation activities appeared to be coincidental rather than deliberate attempts to implement the NQPS.
CONCLUSION: Findings indicate there is an interest in implementing the NQPS in Ghana; however, numerous barriers, particularly those in the larger health system context, such as funding, impeded implementation at all levels. To facilitate the adoption and implementation of NQPS, the policy instrument must be well-developed through an inclusive process and disseminated to all health system levels. An enabling health environment with strong political will, effective governance, local ownership, funding, and other resources is critical for success. Expected implementers need to have the requisite technical expertise and support, including protected time. / 2026-01-08T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47916 |
| Date | 08 January 2024 |
| Creators | Akuamoah-Boateng, Linda |
| Contributors | Wirtz, Veronika J. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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