• Edith Frimpong, Ebenezer Oduro-Mensah, Linda Vanotoo, and Irene Akua Agyepong.
• Department of Dodowa Health Research Center, Ghana Health Service, Research and Development Division, Dodowa, Ghana.
• Int J Health Plann Manage. 2018 Oct 1; 33 (4): e1112-e1123.

AbstractA call center was designed and started implementation in the Greater Accra Region of Ghana in 2015, to support frontline provider decision-making and referral for maternal and new born care. This study aimed to understand the organizational functioning of the center and lessons for design improvement, implementation, and scale-up. The study design was a single case study. Data collection involved participant and nonparticipant observation, conversations, and in-depth interviews with call center staff. Data were coded and analyzed manually. Findings showed a high adherence to call center protocols, good client service skills, a strong local sense of ownership of the center, and staff resilience in performing their functions despite a context of scarce resources and no prior experience with running a call center. Perceptions of lack of involvement of some call center staff in decision-making, and the resource constrained working conditions sometimes hampered the functioning of the center. The locally driven bottom-up process used to establish the center appeared to be an important element in sustaining it despite the resource constraints. More attention to locally driven bottom-up approaches, organizational functioning, and resilience are critical to develop and sustain innovations for health outcome improvement in resource-constrained contexts.© 2018 John Wiley & Sons, Ltd.

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