Case study: Improving the quality of neonatal care by introducing chlorhexidine in Ghana
UNICEF data indicate that infection is a primary cause of neonatal mortality. Neonatal sepsis may occur from umbilical cord infection in low-resource settings where home deliveries are common.12 Ensuring optimal cord care at birth and in the first week of life, especially in low-resource settings, is a crucial strategy to prevent life-threatening sepsis from cord infections, averting preventable neonatal deaths.13 Chlorhexidine digluconate is a widely used, low-cost antiseptic that is effective against neonatal infection. Prior to the Strengthening Health Outcomes through the Private Sector project in Ghana (USAID SHOPS), no umbilical cord care product was available in the private sector in Ghana.
USAID SHOPS support
To promote optimal cord care in newborns in the private health sector, USAID SHOPS worked with the Ghana Health Service and the Ministry of Health to introduce 7.1% chlorhexidine digluconate gel. The introduction of this product for umbilical cord care involved three approaches: supporting the enabling environment, ensuring the availability of the product in the private sector, and ensuring providers were trained in its use.
To support the enabling environment, the project prepared a policy brief and advocated for its inclusion in the national essential medicines list, standard treatment guidelines, and the National Health Insurance Scheme Medicines List. The project worked with the Family Health Division of the Ghana Health Service to create a new working group that would develop the appropriate protocols, guidelines, and training curricula for health workers on the use of the gel for cord care. This effort generated government support for the eventual rollout and oversight of the product.
The product also needed to be made available in the private sector through pharmacies and over-the-counter medicine sellers to ensure wide access and availability. USAID SHOPS identified potential local pharmaceutical firms that had the capacity to import the product and facilitated the market authorization by the Ghana Food and Drug Administration. The project also provided technical assistance to Presoque Company Limited, a subdistributor of the Chlorxy G-Gel (a WHO-certified product), to develop marketing and scale-up plans to promote effective distribution nationwide.
Finally, to ensure providers were trained in its use, USAID SHOPS worked with the Family Health Division and professional associations to train 1,214 pharmacists and 9,409 over- the-counter medicine sellers. The project also worked with the division to conduct a training-of-trainers event so the Ghana Registered Midwives Association’s regional trainers could train their midwife members. Given that the product could be used at home, caregivers needed to be aware of the product and how to use it. The project developed key messages and counseling aids aimed at educating caregivers on the use of chlorhexidine for umbilical cord care.
Results
By the end of the project, 353,814 tubes of 7.1% chlorhexidine digluconate gel had been distributed, 21 percent of over-the-counter medicine sellers and pharmacies stocked the product, and over 10,000 private providers completed training on its use, potentially saving thousands of newborn lives.