Small College in Ghana Makes Big Changes to Train More Health Workers

Photos: Carol Bales/CapacityPlus and IntraHealth

Interviews conducted by Carol Bales and Gracey Vaughn. This feature originally appeared on the CapacityPlus website. CapacityPlus is a global project funded by the US Agency for International Development and led by IntraHealth International.

An accident. A car wreck on the roadside in Kumasi, Ghana. A pregnant woman cut, injured. Ave Maria Quist rushes over to help.

“I applied pressure to the part that was bleeding, and I called for an ambulance,” she says. “Then we took the woman straight to the hospital for further treatment.”

Ave Maria is a midwifery student at nearby Garden City University College. The injured woman was lucky Ave Maria had the skills to help her. Almost 2,000 Ghanaians die every year from injuries caused by road accidents, which are one of the top ten causes of death in the country. But the woman also faced another life-threatening risk: having a baby.

The 2014 State of the World’s Mothers report ranks Ghana as one of the worst places in the world to be a mother (150 out of 174 countries). Women in Ghana face a one-in-68 lifetime risk of dying in childbirth.

Ghana needs more midwives

The country desperately needs more skilled birth attendants to improve maternal health. Only 54% of births are assisted by a trained health worker. Ghana has fewer than half the minimum amount of doctors, nurses, and midwives recommended by the WHO for adequate access to care.

Garden City, a small but rapidly growing private school, recognizes the need to educate more students like Ave Maria. It started a new bachelor of science program in midwifery in 2014, enrolling 65 students in the first year.

If Ave Maria and all her classmates go on to become midwives, together they will provide care for 7,000 more women every week (based on the estimate that a public health midwife in Ghana provides services for 119 clients each week).

And it’s not just safe maternity care they will provide. Midwives play an important role in reducing mother-to-child transmission of HIV and counseling mothers about family planning. Ashanti Region, where Garden City is located, has the second largest HIV epidemic yet reports the lowest coverage (24%) for HIV testing and result reporting. In 2009, only about one-fourth of HIV-positive Ghanaian women and a fifth of their babies received antiretroviral therapy to prevent new infections. Midwives can help change that. They can also address Ghana’s 35% unmet need for family planning. Midwives are trained to describe potential side effects of and dispel myths about contraception and offer a wide range of contraceptives.

Private health professional schools can fill the gap

Private schools like Garden City are expanding rapidly and helping to graduate more health workers. “What the public sector is producing is woefully inadequate,” says Dr. Wilhelmina Donkor, the school’s acting president.

With health training needs only increasing and developing-country budgets not keeping pace, private-sector schools will soon produce more health workers than public-sector institutions.

Garden City’s midwifery program builds on its nursing program, which started in 2007. So far, 340 nurses have graduated and 138 more are expected to graduate this year.

Now Garden City is one of the first schools in the country to offer a bachelor of science degree in midwifery, targeting the population’s health needs and providing a viable career path for midwives—a cadre that previously had few academic and professional opportunities for advancement.

“Midwives were stuck at being registered midwives because they didn’t have any mobility,” says Dr. Donkor. “So over the years when the young ladies started to go to school, they didn’t choose midwifery because they knew they would be stuck there.”

Bottlenecks, best buys, and school management

Health professional schools around the world play an important role in developing a competent workforce that can help achieve national health goals and universal health coverage. But like Garden City, many of these schools have limited resources to scale up their programs.

IntraHealth’s CapacityPlus project is partnering with Garden City and 29 other schools in sub-Saharan Africa to apply innovative approaches for graduating more health workers.

Garden City used CapacityPlus’s Bottlenecks and Best Buys Approach. This new tool helps school leaders assess their current production capacity and identify bottlenecks that are keeping them from scaling up the quality and quantity of graduates and define best buys that have the largest potential for overcoming constraints with the least amount of additional cost.

The school also used CapacityPlus’s forthcoming School Management Package, a set of tools for improving the use of existing resources through examining and refining current management practices.

School leaders identified 47 practices that could be improved, prioritized them according to long-term goals, and worked to streamline management processes in the priority areas. After a year, they used the School Management Self-Assessment Tool to reevaluate the management processes.

The School Management Package includes guidance for modifying DHIS 2 (an open source and freely available software) into a “Dean’s Dashboard” that will allow deans and other school officials to produce graphical reports and quickly gauge progress toward goals.

Big changes

Garden City chose a handful of priority goals, and is already making good headway on meeting many of them.

  1. Increase student applicants and enrollment
    The school developed and began executing a marketing strategy (a best buy) to increase the number of applicants. The school nearly doubled the number of students that enrolled in August 2013 from the previous year—a record number of 850 students. “I have people in the field doing outreach, talking to students who will be graduating from the secondary schools,” says Dr. Donkor. “They also visit social groups in the churches, in the mosque. They’re taking it to the grassroots and letting them know what we have here, that we are a viable alternative.”
  2. Gain accreditation for new programs
    In addition to obtaining approval to start the bachelor of science in midwifery program, the school gained accreditation for additional bachelor of science programs for lab technicians and medical assistants, other types of health workers that are in short supply. “We are the only private university in Ghana that is even offering a medical laboratory technology program,” says Dr. Donkor. And in December 2014, the school gained accreditation for a master’s in nursing program.
  3. Improve the recruitment and retention of high-quality faculty
    The school implemented a competitive, competency-based process for recruiting staff. Dr. Donkor was hired through this process.
  4. Monitor progress toward management goals using a visual reporting system
    The school needed to gather data before it could use a system like a Dean’s Dashboard. CapacityPlus collaborated with the school to identify an appropriate faculty and student tracking system, called SARIS, and the school has already started using it. The school also appointed a data quality manager to improve data collection and use.

Ave Maria’s goals

After Ave Maria graduates and passes her licensing exams, the Nursing and Midwifery Council of Ghana and the Ministry of Health will offer her a position in a health facility or hospital. She says she loves helping women get through labor safely and deliver healthy babies, and she’s got big plans for the future.

“My plan is to do my national service and practice as a midwife for a year or two—and then apply for my master’s.” Next she’ll seek funding to open her own maternity clinic to save the lives of more mothers and babies.


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