Ghana Government Plans to Scale Low-tech, Neonatal Centers
WomenStrong International, a consortium of non-profit organizations in five nations supporting women-driven solutions to extreme urban poverty, announced today that Ghana’s Health Service and Ministry of Health have adopted an innovative, low-resource approach to caring for sick and pre-term newborns piloted by WomenStrong and its predecessor, the Millennium Cities Initiative of Columbia University.
Developed by Israeli neonatologists and spearheaded by WomenStrong Consortium member Women’s Health to Wealth in Kumasi, Ghana, the low-cost, low-tech approach was acknowledged by the government as an effective model that can be used in neonatal care throughout Ghana.
Women’s Health to Wealth Director Abenaa Akuamoa-Boateng was honored earlier this summer alongside pioneering Israeli neonatologist Dr. Michael Karplus , whose team at Israel’s Ben Gurion University has contributed significantly to improving neonatal care in developing countries through innovative approaches and processes adapted for low-resource environments.
Akuamoa-Boateng and Dr. Karplus joined forces in 2008 to address the deadly overcrowding at Kumasi’s only neonatal intensive care unit (ICU), located at Komfo Anokye Teaching Hospital (KATH). The hospital’s neonatal ICU was the only facility caring for premature, low birthweight and sick newborns for a population of more than five million people across the Ashanti region and areas to the north.
Designed to serve a maximum of 50 babies at a time, the neonatal ICU often had five times that many receiving care. A crib or incubator meant for a single infant might be shared by five newborns. Sick babies shared space with preemies or moderately ill newborns who simply needed to be fed, kept warm and allowed to grow. As a result, mortality among infants in the unit approached 50%.
In an initial effort to address this crisis, Dr. Karplus and his team trained physicians, nurses and midwives in neonatal resuscitation and emergency care techniques. But Dr. Karplus was not satisfied. “You cannot teach in this environment,” he said, pointing to the challenge of cross-contamination and stresses on staff from an impossible, risky workload.
So Dr. Karplus embarked on implementing a system and processes he had used previously in Nepal and Uganda to address the needs of moderately ill, low birth weight and premature newborns. In partnership with Akuamoa-Boateng, Karplus identified two viable local venues for establishing two neonatal units from among five government hospitals serving the Kumasi metropolitan area.
With support of MASHAV, Israel’s Agency for International Development Cooperation in the Ministry of Foreign Affairs, the dilapidated building of Suntreso Hospital and an uncompleted building in Kumasi South Hospital were repaired and interiors refurbished to create two low-resource Neonatal Centers, or “Mother-Baby Unit.” The construction of new units took into account matters such as unreliable electrical supply and the need for constant warm temperature and clean water.
A key concept in creating the facilities was to make mothers a central pillar in neonatal care, supplementing overworked staff and replacing costly equipment. South African specialist Karen Davy, invited by Dr. Karplus to join the team, trained caregivers in Kangaroo Mother Care (KMC) . Predicated on the age-old wisdom of the importance of skin-to-skin contact, KMC is a methodology that helps create the all-important bond between mothers and infants and warms babies without the need for costly, hard-to-maintain incubators.
Karplus, who headed the Department of Neonatology at Ben Gurion University’s Soroka Medical Center for nearly 30 years, focused on simple methods for reducing infections, a prime cause of death in vulnerable newborns. Healthy and sick babies were no longer intermingled, sinks were installed to serve every eight beds, and proper hand-washing was taught to mothers and staff.
As a result of the effort, Kumasi saw a 21% drop in the crowding at Komfo Anokye Teaching Hospital Neonatal ICU and an infant mortality rate in the two new Centers of 5% or less. (Infant mortality per 1,000 live births are 37.3 in Ghana overall, 5.87 in the United States and 3.5 in Israel, according to the 2015 CIA Factbook.)
The new facilities offered a fresh approach to treating moderately sick newborns cheaply and without expensive medical intervention. With so few physicians available, all available staff at the Mother-Baby Units — nurses, midwives, medical assistants – were trained to apply simple methods of newborn care that do not require a doctor’s intervention. Additional training in inventory and procurement management were conducted by volunteers sponsored by pharmaceutical giant GSK.
“Sick babies can’t wait, so the trainings that assure everyone knows exactly what to do are as important as the physical facilities,” said Akuamoa-Boateng, who led the work — from overseeing construction during the facility rehabilitation, to training hospital staff in record-keeping, to teaching individual mothers to nurse.
In recognition of her eight-year effort and decades of expertise, the Government of Ghana invited Akuamoa-Boateng to join Ghana’s National Neonatal Subcommittee to duplicate nationwide the neonatal model she helped create in Kumasi. Some parts of Ghana already have adopted the new model and the government’s goal now is to outfit every other region within Ghana with similar Neonatal Centers.
