National in scope, the project will begin in the northern sector and expand to the rest of the nation in waves, to cover an estimated 3.3 million children under the age of five.

Aims and Objectives 

Project Fives Alive! seeks to assist Ghana in reaching Millennium Development Goal 4 (which focuses on improving child health). The goals and objectives of the project align directly with Ghana’s current interventions to reduce under five morbidity and mortality.

Aims:

1. Assist and accelerate Ghana in reducing mortality in children under the age of five by 60 percent by 2015.

2. Disseminate effective, large-scale improvement models to other health systems throughout Ghana.

Objectives:

1. Use systems improvement methods to test, apply, and spread changes that will improve child health and decrease the impact of the most destructive diseases and conditions for infants and children under five (malaria, neonatal diseases, malnutrition, pneumonia, and diarrhea)
2. Increase the access and utilization of high-quality health care services, both within the existing health care systems and in local communities
3. Improve the systems that are essential to supporting care: financing, human resources, information, clinical guidelines, and health sector partnerships
4. Improve the capacity of national, regional, and district health care workers from all levels of care, within all systems of care, to continually improve the reliability, quality, continuity, and safety of under five care in Ghana
5. Disseminate effective models of care on a large scale throughout Ghana, other nations, and other faith-based systems

These aims and objectives are supported and instituted by two guiding methods, including the Model for Improvement and the IHI Breakthrough Series Collaborative methodology. Every tier of the project helps to ensure the success of the specific interventions that the program is testing.

Under Five Population Health

Health of children under the age of five is viewed as an indicator for general population health. While mortality rates for children under five have been decreasing since the 1980s, about one in every five children still die before their fifth birthday. Children under five in Ghana face a myriad of health concerns such as malaria, poor neonatal care, diarrhea, pneumonia, and malnutrition, which may lead to death.

Strategy 

Project Fives Alive! focuses on using specific interventions and indicators of success to improve the health and care of the under five population, guided by High Impact Rapid Delivery (HIRD), a program of the Ghana Health Service. The program also focuses on providing care to mothers. Specific interventions of the HIRD program include:

• Distribution of insecticide treated nets to pregnant women; 
• Folate and iron supplements given to women during pregnancy;
• Attendance by a skilled health professional during delivery;
• First neonatal visit within two days of birth; and 
• Vaccination of infants and children from preventable diseases.

Learning Networks

Part of the strategy, the learning networks are composed of representatives from different types of health facilities and from the National Catholic Health Service and the Ghana Health Service. The networks are a way for individuals from all levels of the health system to come together and share ideas. This way, the knowledge that different clinics are gathering by testing changes is spread and the exchange of new ideas and best practices is accelerated.

Progress

Project Fives Alive! has made significant progress in terms of postnatal care, with over 90 percent of newborns registered for care in March 2009 and over 50 percent of these newborns registered and seen within two days of life.

The Road Ahead

Project Fives Alive! will continue to focus on building the skills of front-line health providers and their managers to apply quality improvement methods in a continuous and sustainable manner. Improving data recording methods and analysis will be essential to evaluating the impact of the program going forward.

Travels in Ghana: Read stories from the Project Fives Alive! team's site visits

This graph is a depiction of how the interventions and changes made in
Project Fives Alive! will spread across Ghana.

More about Ghana

In rural Ghana, many families fear the “evil eye” — people who see newborns early in their lives and do not wish the family well, thereby causing the newborn to die. Health care workers are not included in this group, but there is a fear that these people will encounter the newborn on the way to or at clinics. In light of this fear, many women are reluctant to seek skilled delivery at health facilities or to return to health facilities for first week check-ups. Some clinics have been able to provide skilled delivery and postnatal care in the woman’s home in order to honor this traditional belief while providing essential care to mothers and their babies.

Geography

Ghana is located in West Africa and is bordered by Burkina Faso, Cote D'Ivoire, Togo, and the Gulf of Guinea. Project Fives Alive! currently works in three districts across Northern Ghana — West Gonja district, Navrongo-Bolgatanga diocese, and Jirapa-Lambussie district — with plans to spread throughout the entire country by 2012.

Country Statistics

• Population: 23,008,000
• Life expectancy at birth: 56 (males), 58 (females)
• Under 5 mortality rate: 120/1,000 live births
• Doctor-to-patient ratio: 15/100,000

[Source: World Health Organization, Country Statistics 2006]

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