Effects of a computerised clinical decision support system and performance-based incentives on maternal healthcare providers in Northern Ghana.

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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.
A thesis submitted to the Department of Population, Family and Reproductive Health, College of Health Science, School of Public Health in partial fulfillment of the requirements for the award of the degree Doctor of Philosophy in Public Health,