OTIP

Obstetric Triage

Implementation

Package

An end-to-end implementation protocol -

not a training course, not an app.

OTIP combines clinical tools, workflow redesign, quality improvement and governance into a single implementation approach designed to absorbed into routine hospital practice. The goal is not to create a dependency on Kybele – it is to change how the hospital works, permanently.

Triage assessment form
Structured risk-stratification tool completed on arrival. Scores clinical urgency and directs immediate action. Replaces clinical intuition with a reproducible protocol.

Color-coded wristband system
Immediate visual communication of risk level across the ward. Every member of staff knows – at a glance – which women require urgent attention.

Dedicated triage space and workflow redesign
Physical and operational reconfiguration of the admission area. Designed to work within existing infrastructure – no new construction required.

Clinical champion training program
Facility-based champions trained to lead implementation and sustain the protocol through staff rotations. The model is designed to survive personnel change.

Treatment protocols for high-risk conditions
Condition-specific escalation pathways for eclampsia, hemorrhage, obstructed labor, and sepsis. Embedded into the triage workflow so action follows assessment immediately.

Simulation game
A role-play scenario tool that builds clinical confidence and team co-ordination before the protocol goes live. Used in initial training and in ongoing QI refreshers.

Monitoring, evaluation, and QI infrastructure
Real-time data tools integrated into the hospital’s existing records. Audit cycles, peer review, and feedback loops that catch gaps and drive continuous improvement after Kybele leaves.

Independently evaluated.

Not an improvement – a transformation.

An external evaluation by the Institute for Fiscal Studies (IFS) of the national scale-up in Ghana shows a causal reduction in institutional maternal mortality of 106 deaths per 100,000 deliveries, relative to a control mean of 124. This represents an approximately 60% reduction in institutional maternal mortality across referral hospitals.

The evaluation used economic methods to establish causality – ruling out confounding factors including changes in facility use, patient demographics, and national health trends.

Produced by Grand Challenges Canada, April 2025

Results at a glance

Published research

~60%

Reduction in institutional maternal mortality

IFS independent evaluation – Ghana referral hospitals

Addressing the Third Delay: Implementing a Novel Obstetric Triage System in Ghana

BMJ Global Health, 2018

85%

Of women seen within 10 minutes of arrival

Up from 5% at baseline – 12 months post-implementation

The Introduction of a Midwife-led Obstetric Triage System into a Regional Referral Hospital in Ghana

Midwifery, 2018

650K

Women reached by OTIP

Through government-led triage to date

A Protocol for Evaluating a Multi-level Implementation Theory to Scale-up Obstetric Triage in Referral Hospitals in Ghana

Implementation Science, 2020

$739

Estimated cost per maternal death averted

IFS cost-effectiveness analysis

The Third Delay: Understanding Waiting Time for Obstetric Referrals at a Large Regional Hospital in Ghana

BMC Pregnancy and Childbirth, 2017

126:1

Estimated benefit-to-cost ratio

Comparing economic value of lives saved to program cost

National Scale-up of OTIP: IFS Independent Evaluation of Impact on Institutional Maternal Mortality

International Journal of Obstetric Anesthesia (IJOA), 2026

Co-designed with the Ghana Health Service

Now government policy. Now government budget.

OTIP began at Greater Accra Regional Hospital in 2012. Over the following decade, in partnership with the Ghana Health Service (GHS), it expanded across referral hospitals, was adopted as national triage policy, and was integrated into GHS training, supervision, and domestic financing. Kybele’s operational role has ended. The protocol runs without us.

2012

FIRST IMPLEMENTATION – GREATER ACCRA REGIONAL HOSPITAL

One facility – pilot phase

2019

NATIONAL TRIAGE CHAMPION NETWORK ESTABLISHED

GHS led training – peer-to-peer spread

2024

110+ GHS FACILITIES – NATIONAL POLICY – DOMESTIC BUDGET

$0.62/Birth – 650,000 women reached – GHS Excellence Award

OTIP is made possible by the M. Jean Fisher Charitable Trust and the following organizations: