Our Approach: AMANI
Advanced Maternal and Newborn Care Initiative
THE PROBLEM
In Ghana, 45 babies out of every 1,000 are either stillborn or die within a week of delivery (1) – over 33,000 deaths a year. Nearly all of these deaths are preventable. While Ghana has made laudable progress, acceleration is needed to meet the Sustainable Development Goal targets of a stillbirth and newborn mortality rate below 24 per 1,000 live births by 2030. These rates can only be achieved through strengthening the quality of advanced care in higher-level facilities (regional referral and district hospitals) that provide care for complex pregnancies and small and sick newborns.
THE ADVANCED MATERNAL AND NEWBORN CARE INITIATIVE (AMANI)
Since 2020, with funding from the Children’s Investment Fund Foundation’s Making Every Baby Count Initiative (MEBCI), the Ghana Health Service (GHS) has been, with support from Kybele and partners (PATH, Hatch Technologies, AYA Collective, and African Health Supplies):
- Developing an advanced care package to strengthen care in higher level facilities across the entire hospital journey of the mother and the baby;
- Testing and evaluating the package in four regional referral hospitals (Greater Accra, Eastern, and Sunyani Regional Hospitals and Tema General Hospital) and a modified version in five district hospitals; and
- Preparing for the scaling of the package across Ghana’s highest-volume facilities.
The advanced maternal and newborn care package includes:
- 11 clinical and operational modules and job aids that address gaps and establish evidence-based care standards. There was a knowledge gain of 21% (pre-test 63%, post-test 84%) amongst the 2,867 clinicians trained to date.
- Novel, contextually appropriate process innovations, co-designed with GHS, which enable standards to be embedded despite resource constraints.
- System-level interventions, covering all of the building blocks of the health system to create an enabling environment for quality service delivery.
The package is scalable. A cadre of master trainers has been developed within GHS to facilitate rollout, with modules integrated into GHS’s e-learning platform. The package is also designed for sustained impact. For example, to address high staff attrition (11%-20% per year in the four hospitals) an In-Service Training package has been developed for onboarding new and rotation clinicians in Newborn Intensive Care Units (NICUs).
THE IMPACT
Facility records show that there was a 19% reduction in institutional perinatal mortality by 2024 (14% for early newborn mortality, 35% for stillbirths), implying that scaling to Ghana’s high volume facilities could save 1,850 newborns and avert 3,800 stillbirths a year. An external evaluation by the London School of Hygiene and Tropical Medicine will report in 2026.
(1) Punguyire D, Koray MH, Abiiro GA. Predictors and prevalence of perinatal mortality in Ghana: a systematic review and meta-analysis. BMC Public Health. 2025 Oct 3;25(1):3330. doi: 10.1186/s12889-025-24703-y.
Click to DOWNLOAD the 3-page AMNCP Brief
MATERNAL ELEMENTS OF THE PACKAGE
The Obstetric Triage Implementation Package (OTIP) and Modifed Early Obstetric Warning System (MEOWS) enable rapid assessment of incoming pregnant women, risk-based prioritization, and timely monitoring for deterioration. Previously, hospitals used a first-come first-served approach
which delayed care for time-sensitive, life-threatening complications. OTIP and MEOWS have been scaled nationally to 110 facilities, reducing the average waiting time from 70 to 5 minutes, and improving clinical outcomes e.g., a 16 percentage point increase in high-risk pregnancies
administered drugs for complications.
The C/Safe perioperative care bundle addresses high mortality after C-section through structured clinical handovers, accelerated recovery protocols and postpartum monitoring interventions. C/Safe has increased the proportion of mothers with one or two fundal checks from 41% and 7% to 88% and 57% and the provision of essential newborn care components from 31% to 82%.
The Premcare module specifically addresses the care to be given to the mother who presents with or is expected to deliver a preterm baby. The module optimizes neuroprotection, infection prevention, and lung maturation. It includes the additional care to be given to the baby at birth
and in the first few hours after birth to improve outcomes.
NEWBORN ELEMENTS OF THE PACKAGE
The Designated Assessment and Resuscitation Team (DART) are experienced nurses and midwives who are trained to attend high-risk deliveries, initiate high-level resuscitation, and provide stabilization and intra-hospital transport to the NICU with a novel system that provides CPAP, thermoregulation and continuous monitoring for sick babies. DART has improved resuscitation of high-risk deliveries and early identification of newborn complications, resulting in decreased admissions (from 45% to 35% of total deliveries) and perinatal asphyxia.
The Postnatal Care Module trains midwives to conduct daily examinations of babies using the Newborn Early Warning Signs (NEWS) chart, enabling midwives to promptly identify newborns with signs of deterioration.
The five Neonatal Intensive Care Modules equip medical teams with contemporary evidenced-based care templates on how to respond to clinical conditions and complications for small and sick neonates admitted to the NICU. Modules include
- Initial Assessment & Stabilization,
- Fluids & Nutrition,
- Hyperbilirubinemia,
- CPAP with oxygen Blending,
- Operating the bCPAP machine
The Pre-referral Stabilization Module enables safe transfer of sick or small newborns from District to Regional Hospitals.
SYSTEM LEVEL INTERVENTIONS
- Leadership and Governance: leadership training modules, new national newborn care guidelines, which have been formally adopted by GHS.
- Service Delivery Strengthening: instituting Neonatal Mortality Reviews (where hospitals analyze recent newborn deaths to identify opportunities to improve care), Quality Improvement modules (to empower local teams to identify performance gaps and implement data-driven solutions), and a clinical Peer Review approach (where teams evaluate other hospitals’ adherence to standards). Under the Peer Review process, hospitals increased average scores from 44% to 78% between rounds one and three.
- Human Resources: In-Service Training package for new and rotated NICU Nurses to ensure maintained competency of staff despite high attrition.
- Supplies: standardized equipment, supplies, and maintenance bundle.
- Data: integrating advanced maternal and newborn care forms into the national electronic medical record system.
- Finance: demonstrating the return on investment for adequate staffing and resources for advanced care, costing schedules for the deployment
and maintenance of equipment.
