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Project Design


Project Fives Alive! is designed upon three pillars.

Firstly, the project is closely aligned with the High Impact Rapid Delivery (HIRD) Program for maternal and child health, a national program launched by the Ghana Health Service in 2006.  Our focus is to improve the quantity (coverage), quality, reliability and patient-centeredness of the HIRD Program using quality improvement (QI) methods and tools (see Figure 1).

 Figure 1: Project Fives Alive!s Quality Improvement Focus

Secondly, the core QI framework upon which the project is designed is the Model for Improvement, which enables the project staff and the local QI teams with whom they work to set aims, identify process failures and develop, test and assess whether changes are leading to improvements (see Figure 2).

The Improvement Collaborative Network, which accelerates peer-to-peer learning and improvement on a large scale (see Figure 3), is an integral part of the project’s design. The local QI teams convene at a Learning Session every four to six months to acquire QI knowledge and skills, and to share their QI experiences and learn from their peers’ successes and challenges. During the intervening Activity Periods, they apply what they have learned, with support from their district managers and the project staff who visit them monthly to assist with development and testing of change ideas, and implementation and sustainability of successful changes.


Figure 2.Model for Improvement                                   Figure 3. Improvement Collaborative Network

                                                                                    source: Associates for Process Improvement

Thirdly, after a period of developing and testing change ideas to improve care processes on a small scale (Wave 1 – four districts/dioceses and Wave 3 innovation phase), the project distills the most successful changes and “packages” them up into a simplified set of changes that can be easily adopted by other QI teams that were not involved in the initial innovation and testing phase. This simplified set of changes, or change package, facilitates the adoption of innovation at large scale (Wave 2 – 38 districts and Wave 3 –33 hospitals). It also facilitates efficient management and analysis of the change process across regions and ultimately across the country.

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