Improving maternal health remains the most elusive of the Millennium Development Goals (MDGs) with the probability that a sub-Saharan African mother will die from complications of pregnancy and childbirth is 1 in 16, compared to 1 in 3,800 in industrialized countries.
Any intervention protecting the health of mothers and newborns through better health care is also of benefit to society and its development, for which a healthy population is the main resource.
In addition to a lack of financial and human resources in developing countries, health care is endangered by quality deficiencies caused by low staff motivation. This lack of motivation leads to an insufficient translation of knowledge into optimal utilization of resources.
A computer-assisted clinical decision support system (CDSS) will be developed, implemented and tested aiming at (i) quality improvement of maternal and newborn care and (ii) assessment of provider performance. Based on this tool a commonly agreed incentive scheme to increase motivation will be shaped and tested in three sub-Saharan African (SSA), namely Burkina Faso, Ghana, and Tanzania.
The incentive scheme may contain both non-monetary and monetary incentives and will be designed according to the human resource policy in the three countries. The planned approach is an implementation study with control arms containing one hospital and six first line health facilities in each of the study districts and an equal number of facilities in the control arm.
A set of indicators for measurement of changes in quality of delivered services will be identified in order to follow up the sustainability and effectiveness of the strategies after implementation. The study findings will allow understanding the important factors of staff motivation and facilitate adequate management for improvement of maternal and neonatal health care.