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In 2019, the Saving Lives @ Birth consortium awarded Kybele-Ghana a grant to introduce an Obstetric Triage Implementation Package (OTIP) designed to identify and promptly attend to at-risk, expectant mothers as soon as they arrive at a hospital to give birth.
Kybele, a global health nonprofit organization, developed the program after spending over a decade working with the Ghana Health Service observing, researching, and teaching maternal health at regional hospitals.
According to the World Bank Group, Ghana has 308 maternal deaths in pregnancy and childbirth for every 100,000 live births – a rate more than 16 times higher than the United States. Oftentimes, when Ghanaian women arrive at a hospital to give birth, they are already in a compromised state and it may be hours before they are seen by healthcare providers.
Referred to as the “third delay,” this dangerous waiting period can quickly lead to preventable life-threatening obstetric complications that are the cause of nearly 80% of maternal deaths. Timely assessment and treatment can make the difference between life and death for both mother and her baby.
“This avoidable crisis is not just plaguing Ghana – it’s happening in low-resource settings around the world,” said Dr. Medge Owen, project lead and founder of Kybele. “These local hospitals face unique barriers – they’re often understaffed, underfunded, and lack access to critical supplies.
OTIP addresses these challenges through a triage program that maximizes a hospital’s limited staff and resources and utilizes a ‘train-the-trainer’ methodology, eliminating the need for costly courses.”
OTIP introduces the obstetric triage model in an easy-to-apply format that helps midwives make quick and accurate decisions in high-stress situations. Based on their assessments, midwives prepare an immediate care plan based on a patient’s risk level, which is easily identified by a color-coded wrist band given to the patient.
The OTIP manual also includes resources such as checklists for triage materials, assessment and monitoring forms, and risk identification charts. The manual even outlines a “Triage Champion” job description to help hospitals identify staff members who can lead triage implementation.
"In developing this program, we knew we needed a long-term, sustainable solution – one that would significantly reduce waiting times and increase positive outcomes, while also enhancing standards of care within healthcare facilities,” said Dr. Owen. “Because this is a system that can be taught and easily executed anywhere, under any circumstance - we have the opportunity to save the lives of women and their newborns.”
From 2013-15, Kybele and the Ghana Health Service piloted the first OTIP program at the Greater Accra Regional Hospital, one of Ghana’s largest birthing facilities. Since then, the program has been scaled to nine other high-volume hospitals – resulting in the training of over 500 front-line health personnel and serving more than 50,000 women.
The international standard is that patients wait no longer than 10 minutes from hospital arrival to assessment by a healthcare provider. In Ghana, among participating hospitals, only 5% of patients were seen within 10 minutes of hospital arrival.
After OTIP, 85% of patients were evaluated within the recommended timeframe. In addition, the documentation of a diagnosis and treatment plan increased to over 99%!
At the time of this release, Kybele has been approached by researchers and public health organizations to implement OTIP in other countries. We are hoping for broader national scale-up and adoption in Ghana and the program will be introduced in Liberia with training led by Ghana’s National Triage Champions, marking its first use outside the Ghanaian health system.
This product is made possible through the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Norwegian Agency for Development Cooperation (Norad), the Bill & Melinda Gates Foundation, Grand Challenges Canada, the U.K.
Department for International Development (DFID), and the Korea International Cooperation Agency (KOICA). It was prepared by Kybele and does not necessarily reflect the views of the Saving Lives at Birth partners.