An exploratory case study of the organizational functioning of a decision‐making and referral support call center for frontline providers of maternal and new born care in the Greater Accra Region of Ghana

A 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.