Ghana has pioneered the use of an Obstetric Triage Implementation Package (OTIP) with midwives in hospitals across the country. Findings from a large-scale study have shown impressive results: a randomised controlled trial across a subset of hospitals included in Ghana’s national rollout provided causal evidence of OTIP’s impact on care processes, midwife knowledge and leadership, and timely treatment of complications. An accompanying analysis using data from hospitals across the country estimated decreased maternal mortality rates. This makes OTIP one of very few interventions with causal evidence of maternal mortality reduction.
OTIP was developed as a partnership between the Ghana Health Service (GHS) and the NGO Kybele. It is a midwife-led protocol to improve the quality of care for pregnant women, with a focus on early identification and prioritisation of high-risk patients. After early pilots demonstrated success, it was implemented in Ghana’s high-volume hospitals (those with more than 1,200 deliveries in 2022) between 2023 and 2025.
OTIP represents a critical shift away from treating pregnant women in need of medical assistance on a first-come, first-served basis. While Ghana made significant progress in maternal and newborn health in the first decades of the 21st century, the average maternal and neonatal mortality rates in the country remained far above global averages and the related Sustainable Development Goals. OTIP’s skilled triage approach to recognising and managing obstetric complications in a timely way has helped prevent maternal and neonatal deaths.
A key innovation in the delivery of the protocol is the use of Champions: a small group of midwives in each hospital trained to rapidly triage and risk-categorise patients, and to lead the protocol rollout — including disseminating knowledge to their peers, allowing national rollout at a fraction of the cost of training all midwives directly. Crucially, study findings reveal that how Champions are chosen shapes OTIP’s success: hospitals where midwives democratically selected their own Champions rather than having them appointed by hospital management saw significantly larger improvements in knowledge dissemination and care practices.
In this conversation, we will learn more about the research findings, including the benefits of appointing Champions through peer selection, and the GHS’ experience of OTIP, including the development process and its partnership with Kybele. The crucial role that research evidence has played in strengthening and scaling OTIP will be discussed. Plans for scaling OTIP further, both in Ghana and in other countries looking to Ghana as a regional centre of excellence, will also be covered.
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Webinar recording
Presentation
Speakers
Associate Director,
Institute for Fiscal Studies
Britta Augsburg is an Associate Director at the Institute for Fiscal Studies, where she leads the Human Capital Development research group. Her research focuses on how policies and programmes can improve child and maternal outcomes at scale in low- and middle-income countries, often in direct collaboration with governments to rigorously evaluate their programmes and inform decisions about scale-up.
She has over 15 years’ experience designing and leading complex impact evaluations – including randomised controlled trials across India, Pakistan, Nigeria and Mongolia.
As part of the Thrive programme, Britta is leading the evaluation of the Obstetric Triage Implementation Package (OTIP), an innovative midwife-led training initiative in Ghana designed to reduce maternal and neonatal mortality, and the testing of a kindergarten intervention aimed at strengthening play-based learning and parental engagement.
Program Manager – Obstetric Triage Implementation Package (OTIP), Kybele Ghana
Robert Asambobillah is a public health and development professional with over 15 years of experience managing and coordinating public health programs, with a particular focus on Maternal, Newborn, and Child Health. He holds a Master’s degree in Public Health from the Royal Tropical Institute/Vrije Universiteit Amsterdam.
Robert is currently the Program Manager for the Obstetric Triage Implementation Package (OTIP) at Kybele Ghana and has been closely involved in its implementation, scale-up, monitoring, and sustainability across high-delivery-volume hospitals in Ghana. He works closely with the Ghana Health Service, frontline health-care teams, and development partners to translate evidence-informed approaches into routine practice.
At this Thrive in Conversation session, Robert will share the OTIP story, highlighting the implementation journey, the impact achieved, and lessons learned from scaling an obstetric triage innovation in Ghana.
Deputy Director,
Family Health Division,
Ghana Health Service
Dr Chris Fofie is the Deputy Director for Reproductive, Maternal and Child Health in the Family Health Division at the Ghana Health Service headquarters in Accra. He is a consultant obstetrician-gynaecologist with a Master’s in Public Health from Sheffield Hallam University.
Dr Fofie is a leading public health figure in Ghana, with a focus on reproductive, maternal and adolescent health, and is actively involved in strengthening healthcare systems and improving life-saving interventions.
Host
Senior Researcher
Christian Michelsen Institute, Bergen, Norway
Thrive Research Director and
Thrive Tanzania co-Principal Investigator
Bet Caeyers has a PhD in Economics from Oxford University. She has extensive experience living and working in Sub-Saharan Africa and is currently based in Rwanda. Her research focuses on policy and programmatic strategies for scaling social protection and human development services, particularly in early childhood development. Her work combines rigorous measurement, innovative programme design, and evaluation of cost-effective, scalable interventions for national implementation.
About the series
We know that investing in early childhood is transformative for both children and societies in low- and middle-income countries, but there are gaps in our knowledge about how to move from pilot to scale and how to ensure long-term quality.
The exchange of insights and ideas between researchers and policymakers is a vital part of bridging these gaps – ensuring that new research addresses the questions most relevant to national decision makers, and that early childhood development policies are grounded in evidence about what works at scale.
This discussion series from Thrive brings together policymakers, practitioners and researchers to explore the latest evidence related to scaling early childhood development programmes in low- and middle-income countries. Conversations will explore the key takeaways from research highlighted in the Thrive What to Read newsletter and delve into how new evidence can help to inform diverse policy and research agendas associated with scaling.
Attendees can take part in live Q&As with leading experts and be part of a growing community of knowledge shaping the future of early childhood development programming.
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The Thrive 2025 scientific conference on scaling early childhood development programmes and policies in low- and middle-income countries, brought together early childhood development researchers, practitioners, funders and policymakers to exchange ideas. Revisit keynote presentations and other sessions from across the conference here.