What do you do with success? The science of scaling up a health systems strengthening intervention in Ghana (original) (raw)
Related papers
PLOS ONE
Background Improving child and maternal health remains a core objective of global health priorities, extending from the millennium development goal (MDG) era to the current focus on the Sustainable Development Goals (SGDs). This paper analyses the childhood morbidity effects of the Ghana Essential Heath Interventions Program (GEHIP), a community-based health systems strengthening in rural northern Ghana. GEHIP was a five-year embedded implementation science plausibility trial that implemented a set of health systems strengthening strategies and tested the proposition that their combined effect at the district, subdistrict and community levels could foster effective community engagement and thereby improve maternal and child health outcomes. Methods A two stage random sample survey of reproductive-aged women residing in treatment and comparison districts at the GEHIP baseline and end line was used for Heckman Difference-in-differences (DiD) regression models for estimating the increm...
When a Navrongo Health Research Centre experiment demonstrated that community-based health services could reduce child mortality and fertility in impoverished communities, the Government of Ghana launched the Community-based Health Planning and Services (CHPS) Initiative to scale up results. This article reports on a "Qualitative Systems Appraisal" (QSA) of factors explaining why CHPS is implemented in some districts, but stalled in others. QSA consists of groups representing levels of the service hierarchy (community members, frontline service providers, supervisors, and district managers) to portray systemic reactions to CHPS. Community members are *189 enthusiastic about CHPS and willing to mobilize labor and resources for constructing nurse accommodations. Participating staff are supportive, but staff not yet participating are apprehensive about the program. Nurses worry about their transfer to communities; supervisors and managers worry about constrained fuel, equipment, drugs, facilities, and manpower resources. Demonstrating CHPS at functioning sites clarifies ways to bridge resource gaps, address concerns, and build consensus for the implementation process.
Research projects demonstrating ways to improve health services often fail to have an impact on what national health programs actually do. An approach to evidence-based policy development has been launched in Ghana that bridges the gap between research and program implementation. The Community-based Health Planning and Services (CHPS) initiative employs strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteers, resources, and cultural institutions to support community-based primary health care. Over the 1999 to 2002 period, 100 out of the 110 districts in Ghana adopted a CHPS initiative. This paper reviews features of the initiative that explain its success and constrain future progress.
Global Health: Science and Practice, 2013
The original CHPS model deployed nurses to the community and engaged local leaders, reducing child mortality and fertility substantially. Key scaling-up lessons: (1) place nurses in home districts but not home villages, (2) adapt uniquely to each district, (3) mobilize local resources, (4) develop a shared project vision, and (5) conduct ''exchanges'' so that staff who are initiating operations can observe the model working in another setting, pilot the approach locally, and expand based on lessons learned.
BMC health services research, 2013
During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birth - from a total fertility rate of 5.5 in only five years. In 2000, the government of Ghana launched a national program called Community-based Health Planning and Services (CHPS) to scale up the Navrongo model. However, CHPS scale-up has been slow in districts located outside of the Upper East Region, where the "Navrongo Experiment" was first carried out. This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening CHPS, especially in the areas of maternal and newborn h...
2021
Background: Ghana has adopted the community-based health planning and services (CHPS) programme as the public health strategy for meeting its universal health goals. The programme is facing implementation challenges that are affecting its expansion within the communities. This research was undertaken to examine the implementation processes of CHPS and suggest solutions to improve its scaling-up within the communities.Method : An exploratory research design was used with a mixed method approach that involved the testing of a hypothesis. Results : The study found that in places with on-going CHPS programmes, there is statistically significant (p<0.001) evidence that the implementation processes are not flawed. However, the district assemblies were selective in the allocation of CHPS zones within the communities. Conclusion : Chieftaincy conflicts within the communities are impeding the community entry aspect of the CHPS policy implementation processes and needs to be addressed by p...
BMC Health Services Research
Background: Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. Methods: We used qualitative data from key informant interviews and annual progress reports from the five Population Health Implementation and Training (PHIT) partnership projects funded through AHI in Ghana,
Frontiers in Public Health
BackgroundDespite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub–Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme.MethodsWe conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understan...
PLOS ONE
Background The Ghana Health Service in collaboration with partner institutions implemented a five-year primary health systems strengthening program known as the Ghana Essential Health Intervention Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished region of northern Ghana around the World Health Organizations (WHO) six pillars combined with community engagement, leadership development and grassroots political support, the program organized a program of training and action focused on strategies for saving newborn lives and community-engaged emergency referral services. This paper analyzes the effect of the GEHIP program on child survival. Methods Birth history data assembled from baseline and endline surveys are used to assess the hazard of child mortality in GEHIP treatment and comparison areas prior to and after the start of treatment. Difference-indifferences (DiD) methods are used to compare mortality change over time among children exposed to GEHIP relative to children in the comparison area over the same time period. Models test the hypothesis that a package of systems strengthening activities improved childhood survival. Models adjusted for the potentially confounding effects of baseline differentials, secular mortality trends, household characteristics such as relative wealth and parental educational attainment, and geographic accessibility of clinical care. Results The GEHIP combination of health systems strengthening activities reduced neonatal mortality by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a null
PLOS ONE
Background In 1999, Ghana introduced the Community-Based Health Planning and Services (CHPS) as the key primary health care strategy. In this study, we explored the challenges, capacity development priorities, and stakeholder perspectives on improving the CHPS concept as it has been fraught with a myriad of challenges since its inception. Our study is the outcome of the national programme for strengthening the implementation of CHPS Initiative in Ghana (CHPS+) introduced in 2017. Methods This exploratory research was a qualitative study conducted in two Systems Learning Districts (SLDs) of CHPS+ in the Volta Region of Ghana from March to May, 2018. Four focus group discussions and two general discussions were conducted among 60 CHPS+ stakeholders made up of health workers and community members. Data analyses were conducted using conceptual content analysis. Statements of the participants were presented as quotes to substantiate the views expressed. Results Negative attitude, high attrition, inadequacy and unavailability of health professionals at post when needed were challenges associated with the health professionals. Late referrals,