Evaluating a Quality Improvement Collaborative to Promote Timely Initiation of Breastfeeding in Ashanti Region, Ghana: A Research Protocol

Timely initiation of breastfeeding within the first hour of life is a critical public health intervention but remains suboptimal in many low-resource settings, including Ghana. Quality improvement collaboratives are a strategy to enhance healthcare practices, but their effectiveness for improving breastfeeding initiation in Ghana requires evaluation. This protocol describes a study to evaluate the impact of a quality improvement collaborative on timely breastfeeding initiation in health facilities in the Ashanti Region, Ghana. The primary objective is to assess the change in the proportion of newborns who initiate breastfeeding within one hour of birth. Secondary objectives include exploring healthcare worker and maternal perceptions of the collaborative and identifying contextual factors influencing its implementation. A mixed-methods, quasi-experimental design will be employed. Twenty-five health facilities will participate in a quality improvement collaborative. Quantitative data on breastfeeding initiation will be collected from routine health records at baseline, during, and after the intervention. Qualitative data will be gathered through focus group discussions with healthcare workers and in-depth interviews with mothers to understand the intervention's mechanisms and contextual influences. Analysis will involve statistical comparison of proportions and thematic analysis of qualitative data. As this is a protocol, no empirical findings are available. The results will present the change in the proportion of newborns breastfeeding within one hour and qualitative themes regarding implementation barriers and facilitators. The study will generate evidence on the effectiveness and implementation of a quality improvement collaborative for improving breastfeeding practices in a regional health system in Ghana. Findings will inform regional and national policy on scaling up quality improvement strategies for maternal and child health. Recommendations will be made regarding the integration of such collaboratives into routine health service delivery. Breastfeeding, quality improvement, collaborative, implementation research, Ghana, maternal health. This protocol outlines a robust evaluation of a quality improvement strategy for a key maternal and child health indicator in a sub-Saharan African setting, with findings intended for health system managers and policymakers.