Complete a case analysis for attached case study and complete questions 1-6.

1. In the report of the results of the initial study there were three recommendations: What do you think of thee recommendations?

a. that the study be continued for up to 3 to 5 years.

b. that the effort go region-wide with compassion being made to a region without the CQI program.

c. that a regional CQI training team be established so that the trainers did not have to neglect their duties in their own district.

2 The tensions between the senior authorities in health care and the provider cadre seems common in less-developed countries. What seems to be behind it? How might CQI contribute to its amelioration.

3.The earliest study reported here showed the negative effects of the “cash-and-carry” system. How has the introduction of the Ghana health-insurance program affected quality, both negatively and positively?

4. Over a ten-year period the use of CQI in Ghana’s Greater Accra region has been a management strategy. What are the strengths and weaknesses in this environment?

5. The Five Alive! program began as an improvement effort in 2008 in rural northern Ghana, eventually partnering with IHI and the Ministry of Health and the Catholic health system, which provides about a third of the care in Ghana. What would you suggest they learn from these earlier experiences?

6. What do you consider to be the controllable variables at the regional level in Ghana that should be studies in support of an expanded quality-improvement effort?