Browsing by Author "Aninanya, Gifty Apiung"

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    Effects of a computerised clinical decision support system and performance-based incentives on maternal healthcare providers in Northern Ghana.
    (NOVEMBER, 2016) Aninanya, Gifty Apiung
    Computerized clinical decision support system (CDSS) and performance-based incentive (PBI) have a potential to contribute to improving motivation and performance of healthcare providers in developing countries. However, there is currently a dearth of rigorous evidence on the effectiveness of these strategies in improving maternal health care in developing countries including Ghana. This study sought to evaluate the impact of CDSS and PBI on motivation and performance of healthcare providers in northern Ghana. The study employed a quasi-experimental design with an explanatory mixed-methods model to assess the effects of the social and technological interventions on motivation and performance of providers. The quantitative research component consisted of a controlled pre- and post-test design, which allowed the quantitative measure of motivation and performance of healthcare providers. To obtain explanatory descriptions of the effects of the interventions on motivation and performance of providers, 66 in-depth interviews (IDIs) with midwives, nurses and their supervisors were conducted in twelve health facilities in the Kassena-Nankana and Builsa districts at intervention endline. A difference-in-difference logistic regression analysis controlling for potential covariates compared variables across intervention and comparison facilities at baseline and endline. Nvivo version 10 was used to analyse qualitative data. CDSS and PBIs were associated with improvements in maternal healthcare providers’ motivation and performance in the intervention facilities compared with the comparison arm. At endline, constructs of motivation that improved were: job satisfaction, intrinsic motivation, organizational commitment, timeliness and attendance. Furthermore, CDSS vi and PBIs strategies improved providers’ management of antenatal and delivery clients. There was statistically significant increase in the proportion of anti-tetanus vaccinations, Human Imuno Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) testing compliance and hemoglobin examined during antenatal care consultations in the intervention sites. Additionally, perceptions of antenatal clients on providers’ technical performance, client-provider interaction and provider availability in the intervention arm at endline improved significantly. Furthermore, delivery clients’ perception of providers’ performance in terms of technical performance, healthcare provider availability and general satisfaction with delivery services significantly improved. Endline qualitative findings revealed that CDSS and PBIs interventions have enhanced providers’ knowledge and adherence to World Health Organisation (WHO) reproductive health treatment guidelines. CDSS prompted them on actions such as diagnosis, prescriptions, checking blood pressures of clients and use of partograph to monitor progress of labour. While the introduction of CDSS and PBIs interventions show positive improvement in healthcare delivery within these selected institutions, there is the need to provide evidence on sustainance mechanisms for large-scale implementation of this intervention. Therefore, future studies on the long-term effects of these interventions are required employing larger samples of different healthcare worker populations, including those of midwives, nurses as well as Medical Doctors.
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    Effects of computerized decision support in the context of a performance-based incentive intervention on maternal and neonatal health-worker performance in Upper East Region, Ghana: A qualitative study of professional perspectives
    (BMC Health Services Research, 2022) Aninanya, Gifty Apiung; Williams, John E.; Williams, Afua; Otupiri, Easmon; Howard, Natasha; 0000-0002-5654-2445; 0000-0001-8986-1648; 0000-0003-4174-7349
    Background: Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of combined CDSS-PBI support on performance in twelve primary care facilities in Ghana’s Upper East Region. Methods: We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 9 software. Results: Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some also reported improved and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software. Conclusions: Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.