In August 2015, based on findings that poor decision making in frontline providers was a contributing factor to maternal and neonatal mortality in Ghana, the Accelerate project initiated a mobile Clinical Decision Making Support System (CDMSS) for frontline providers of maternal and neonatal health in the Eastern region of Ghana. Designed as a cluster randomized control trial (CRCT) and approved by the Ghana Health Service Ethical review committee (GHS-ERC: 10/09/14), the intervention aims to improve maternal and neonatal service delivery and health outcomes. In itself, results of the trial are unable to explain what it is about the intervention that works, for whom it works, in what contexts and how exactly it works (or does not work). Additional evaluation research is therefore needed to aid an in-depth understanding of the explanatory variables for program outcomes. In collaboration with investigators of the CDMSS intervention, this multi-phase comparative case study will employ mixed methods to conduct a realist evaluation of the intervention in three districts – Birim Central, Kwahu North and Birim North. The aim is to comprehensively evaluate the implicit and explicit factors that explain intervention outcomes, as a first step towards making recommendations for implementation and upscaling in other regions of the country. Evaluation will be conducted over a period of 23 months in four phases- exploratory; mid-term evaluation; post-intervention evaluation and post-exit sustainability assessment. This protocol focuses on the activities and budget of the exploratory (phase 1) and mid-term (phase 2) evaluation stages aimed at achieving the mandatory first step in a realist evaluation – development of the program theory and the hypotheses to be empirically tested. On conclusion of the initial phases and analysis of preliminary findings, evaluation tools to test the identified theor(ies) will be designed, and an amendment to the protocol will be sought. Evaluation results will contribute to an understanding of the mechanism through which mHealth can support clinical decision making. Recommendations will be formulated at program, regional and national levels.
|Effective start/end date||24/06/16 → 11/12/18|
IWETO expertise domain