Abstract:
Background: Initiatives to raise the quality of care provided to mothers need to be given priority in Sub Saharan
Africa (SSA). The promotion of clinical practice guidelines (CPGs) is a common strategy, but their implementation is
often challenging, limiting their potential impact. Through a cross-country perspective, this study explored CPGs for
maternal health in Burkina Faso, Ghana, and Tanzania. The objectives were to compare factors related to CPG use
including their content compared with World Health Organization (WHO) guidelines, their format, and their
development processes. Perceptions of their availability and use in practice were also explored. The overall purpose
was to further the understanding of how to increase CPGs’ potential to improve quality of care for mothers in SSA.
Methods: The study was a multiple case study design consisting of cross-country comparisons using document
review and key informant interviews. A conceptual framework to aid analysis and discussion of results was
developed, including selected domains related to guidelines’ implementability and use by health workers in
practice in terms of usability, applicability, and adaptability.
Results: The study revealed few significant differences in content between the national guidelines for maternal
health and WHO recommendations. There were, however, marked variations in the format of CPGs between the
three countries. Apart from the Ghanaian and one of the Tanzanian CPGs, the levels of both usability and
applicability were assessed as low or medium. In all three countries, the use of CPGs by health workers in practice
was perceived to be limited.
Conclusion: Our cross-country study suggests that it is not poor quality of content or lack of evidence base that
constitute the major barrier for CPGs to positively impact on quality improvement in maternal care in SSA. It rather
emphasises the need to prioritise the format of guidelines to increase their usability and applicability and to
consider these attributes together with implementation strategies as integral to their development processes.
