Assessment of quality of care for children in selected hospitals in ...

Assessment of quality of care for children in selected hospitals in Ghana1. Introduction1.1 BackgroundImproving the quality of paediatric care in hospitals is a key challenge in Ghana. Anassessment of the hospital care for children in 2005 showed that the quality of care was notup to the standards recommended by WHO. 1 Although the hospitals had good infrastructuresuch as available water and electricity, case management of common childhood conditionswas below the recommended standard. Emergency care systems were not well established,there were no triaging systems in place, and the emergency units were not well equipped formanaging emergencies. There was a lack of protocols and guidelines for in‐patient care ofcommon childhood conditions (e.g. severe malaria, pneumonia, diarrhoea, malnutrition andHIV/AIDS) resulting in incomplete assessment, treatment and monitoring of cases. Some keyrecommendations were made following the assessment and included the introduction ofemergency systems and provision of guidelines to support case management.As a result of these recommendations, the first training Emergency Triage Assessment andTreatment (ETAT) was conducted in the country in 2007, using WHO guidelines. 2,3 Thetraining included the introduction of the WHO Pocket Book of Hospital Care for Children, 4which provides guidelines on the management of common childhood illnesses. Trainingcommenced in 2007, but limited funding resulted in the involvement of only a few facilities.An opportunity to scale up this initiative on improving the quality of care has now beenprovided by the Better Medicines for Children (BMC) project, which seeks to improve theavailability and access to medicines for children in the country, in line with World HealthAssembly Resolution 60.20 on BMC. 5 One component of the BMC project is to adapt andproduce guidelines for managing childhood illnesses in Ghana.WHO’s framework for quality improvement for hospital care for children 6 outlines the stepsneeded to guide the quality improvement process in countries. This framework describestwo key steps: 1) identifying stakeholders and 2) a situational analysis.This study assessed current paediatric care in hospitals in Ghana against established andaccepted standards of care. The findings will provide the evidence to guide the nationaladaptation of guidelines and standard‐setting process. It is also aimed at improving thequality of paediatric care in hospitals.1.2 Objectives1. Assess the quality of paediatric care provided to children less than five years ofage in hospitals by comparing aspects of paediatric care provided in hospitalswith prescribed standards of care.2. Make recommendations for those facilities that were assessed to improve theidentified gaps that fall within their authority.Page 1