THE JHPIEGO STORY

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Saving Lives from Day OneThe Jhpiego Story

1 out of every 24 babies in Ghana will die before their first birthday.

The struggle to give babies a chance at a healthy life is

truly global. Around the world, 1.1 million newborns die

in their first months of life. The fight to stem the tides

of these deaths is fiercest in Sub-Saharan Africa, where

the newborn mortality rate is highest. As of 2014, out of

1,000 live births, it’s estimated that 41 newborns born in

the region don’t survive.1

Ghana’s infant mortality rate is currently 59th highest in

the world.2 Routinely, newborns die in the first 24 hours

after birth from completely preventable conditions, such

as malaria, sepsis and common infections. Three out of

four Ghanaian babies are born in public health facilities,

attended by midwives, nurses, or other skilled birth

attendants. The number of babies born in facilities has

increased from 14 percent in 1993 to 73 percent in 2014.3

GhanaAFRICA

THE JHPIEGO STORY

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Meet Jhpiego

Created in 1974 as the Johns Hopkins Program for

International Education in Gynecology and Obstetrics,

Jhpiego is a non-profit healthcare organization dedicated

to saving the lives of women and their families in

developing countries. “Jhpiego’s ultimate goal is

sustainability -- leaving behind a well-prepared network

of health care professionals and a strong foundation that

they can build upon when we move on.”4

“Our main focus is to deal with newborn mortality reduction first and foremost, then to reduce stillbirth rates and to abet midwives and providers with skills and knowledge.”

Amos Asiedu Monitoring, Evaluation and Research Officer for Jhpiego

Project Fives Alive! was a program sponsored by the

Ghana Health Service and supported by the Institute

for Healthcare Improvement (IHI) and other partners,

designed to reduce the mortality rate of children aged

five and under through provider training. The program

was a resounding success, decreasing the death rate for

Ghanaian children under five by 32 percent in a five-year

period.5 The IHI described the initiative’s central idea

this way: “Project Fives Alive! emphasizes the use of

local data and local innovation by the frontline providers

who are closest to the processes, thus improving their

capacity for data analysis, data-driven decision-making,

and local ownership of health outcomes.”6

Despite that triumph, Ghana’s newborn mortality rate

was deeply troubling. Babies were dying in the 24- to

72-hour post-birth window from a lack of postnatal

care. Jhpiego adopted the IHI platform for a specialized

newborn program that would offer competency training

that could be scaled to meet the needs of facilities

of every size, in every region, whether in a big city or

remote village. In 2013, Jhpiego received funding from

the Bill and Melinda Gates Foundation for the ambitious

Jhpiego’s inspiration: Project Fives Alive!

three-year program, which would give midwives, nurses

and doctors the knowledge they needed to deliver

immediate, high-quality postnatal care and prevent these

tragic, needless deaths.7

A network of over 100 tutors, equipped with innovative

teaching methods and basic supplies, began delivering

their evidence-based knowledge to the field, instructing

trainees who would in turn pass along their new skills,

creating a culture of ongoing learning. Reducing the

newborn mortality rate in the first 24 hours of life by 25

percent at 110 health facilities in 10 regions of Ghana is

the goal of Jhpiego’s massive three-year effort.

THE JHPIEGO STORY

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The miracle of evidence-based care Evidence-based care combines the most current clinical

expertise and reliable scientific evidence with the

individual needs of the mother and baby. Often, folk

wisdom and personal beliefs heavily influence maternity

practices; by teaching evidence-based practices, local

midwives and nurses who previously couldn’t access the

most current clinical methods are “learning by doing,”

quickly increasing their competence – and saving more

little ones.

“We train providers for a week, and then we give them

one month to practice,” explains Jhpiego’s Monitoring,

Evaluation and Research Officer, Amos Asiedu. “After that

we go again to train them, and then, after they practice for

a year we assess them again.” Additionally, the program

monitors service data to make sure the project is moving

in the right direction. Complications, fresh stillbirth rates

and maternal death rates are also tracked. Pre and post-

training results are compared, and in addition to giving

a picture of each provider’s progress, results are used

to gauge the effectiveness of the program as a whole.

Providers fill out specialized knowledge tests and objective

structured clinical examinations assessments (OSCE) on

paper forms.

At the program’s outset, in addition to completing

documentation by hand, trainees were tasked with doing

their own data entry. The burden of doing double entries

(once on paper forms, then computerizing the same data

manually) increased the possibility for mistakes. And, the

amount of time it was taking for results to come in from

the field was holding the research team back from doing

the analysis they needed to keep the program on track.

“Initially, those who were in training entered the data

themselves. But we realized that they also had to

concentrate on their training in the field,” Amos recalls.

For the first two rounds of the program, training was

done for 28 facilities, generating about 22,000 completed

assessment questionnaires. Both the knowledge

assessment and OSCE are multiple page reports that

require providers to answer anywhere from 50 to 75

questions. “In fact, that was very huge work for us to do,”

he explains. “We had a lot of backlog because we were not

able to get someone to enter for us, and even if someone

was to do it manually, it had to be a double entry. And that

was where the challenge was.” Accurate, quality data was

needed as fast as possible to help program leaders assess

its effectiveness, and to help them make any needed

changes.

Ghana’s lifesavers were drowning in data

THE JHPIEGO STORY

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At last, a workable alternative If the midwives and nurses were no longer taking the

hours needed to input data from their forms, what was the

plan? “Actually, the only thing I had in mind was to hire a

lot of data collectors to go collect our data,” Amos says.

“That was the only option we had until (Jhpiego colleague)

Ms. Allyson Nelson came out and said, ‘What’s going to

help us cut down our manual data input and the people

trying to scan it?’ And that was when the whole team sat

down and considered Captricity.”

Because the trainees were initially entering their own

data from paper into the system’s computers, Amos

and his team had existing data to judge against the

data captured by Captricity. The difference was striking.

“When compared against manually-entered data, the data

extracted with Captricity was much more accurate,” he

notes.

Amos is also pleased with how easy Captricity is to use.

“Whenever I upload my scanned documents the next day

Captricity shreds the data for me. And even online I am

able to view the data points and check whether they are

correctly captured. We are able to edit and then input the

correct data. When a field is blank, you know it’s blank.

And it has been very efficient and very interesting using

Captricity.”

Caprticity’s 99.9%+ accuracy rate is a big asset for Amos,

too. “It helps a lot because normally I am always away

from the office. I’m always in the field,” he explains. “And

what has actually been a help is the quality of the data

being captured as compared to someone sitting behind a

computer inputting it themselves.”

By accurately capturing and transforming handwritten

and typed information into research and business-ready

data, Captricity’s cloud-native platform eliminates the

time, effort and cost of manual data entry. “Big decisions

came when we did the one-year assessment of our Wave 1

facilities and Captricity helped us to make a quick decision

in order to modify our strategy in monitoring,” Amos says.

“I must say it has been very helpful for us using Captricity and very appreciated.”

Amos Asiedu Monitoring, Evaluation and Research Officer for Jhpiego

THE JHPIEGO STORY

Giving organizations faster and easier access to high-quality data to help drive the world forward.

Learn More at Captricity.org

Saving lives is the sweetest success of all

Although research results are still being tabulated as of

this writing, Amos tells us that, based on preliminary data

collected from the Jhpiego project, the fresh stillbirth

rates in Ghana are in decline and the institutional 24-

hour newborn mortality rate is as well. And that’s just the

beginning.

To learn more about Jhpiego’s mission to save

mothers and their children in Ghana and around

the globe, visit

www.jhpiego.org.

SOURCES

(1) http://dhsprogram.com/pubs/pdf/SR224/SR224.pdf

(2) https://www.cia.gov/library/publications/resources/the-world-factbook/geos/gh.html

(3) http://dhsprogram.com/pubs/pdf/SR224/SR224.pdf

(4) http://www.jhpiego.org/content/who-we-are

(5) http://www.ghanaweb.com/GhanaHomePage/health/Project-Fives-Alive-helps-reduce-under-five-mortality-387130

(6) http://www.ihi.org/engage/initiatives/ghana/pages/default.aspx

(7) http://www.gatesfoundation.org/How-We-Work/Quick-Links/Grants-Database#q/k=ghana&page=2