Transforming Rural Health Systems: Evaluating a Centre of Excellence Model for Maternal and Child Health in Rural Northern Ghana

Abstract

This study analyzed the design and impact of the Centre of Excellence (CoE) model in strengthening maternal and child health systems in rural Ghana. A before-and-after design was undertaken to compare baseline 2018 indicators with endline results from 2024. Referral efficiency increased from 45 percent to 78 percent (χ² = 19.8, p < 0.001), while skilled delivery coverage increased from 58 to 74 percent (OR = 3.5, p < 0.001). Antenatal care coverage increased from 72 percent to 89 percent (χ² = 16.2, p < 0.01) and contraceptive coverage increased from 28 percent to 60 percent (OR = 2.9, p < 0.01). The proportion of unintended pregnancies fell by 25 percent, highlighting improved reproductive health outcomes. The qualitative evidence corroborated this quantitative development, as community members trusted the referral systems more, midwives felt more confident after training, and policymakers highlighted better governance and accountability. Integrating workforce training, community engagement, digital health innovations, and financing reforms made the CoE a systemic force for health transformation. Although limited by self-reported data and the geographic scope of implementation, triangulation using facility records and multi-district stakeholder involvement overcame these limitations. Overall, the CoE found that hybrid solutions between structural reforms and community-driven strategies achieve sustainable improvements in maternal health outcomes.