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. 2013 Mar 21;1(1):117-33.
doi: 10.9745/GHSP-D-12-00012. eCollection 2013 Mar.

Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana

John Koku Awoonor-Williams  1 , Elias Kavinah Sory  2 , Frank K Nyonator  2 , James F Phillips  3 , Chen Wang  3 , Margaret L Schmitt  3
Affiliations

Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana

John Koku Awoonor-Williams et al. Glob Health Sci Pract. .

Abstract

Ghana's Community-Based Health Planning and Service (CHPS) initiative is envisioned to be a national program to relocate primary health care services from subdistrict health centers to convenient community locations. The initiative was launched in 4 phases. First, it was piloted in 3 villages to develop appropriate strategies. Second, the approach was tested in a factorial trial, which showed that community-based care could reduce childhood mortality by half in only 3 years. Then, a replication experiment was launched to clarify appropriate activities for implementing the fourth and final phase-national scale up. This paper discusses CHPS progress in the Upper East Region (UER) of Ghana, where the pace of scale up has been much more rapid than in the other 9 regions of the country despite exceedingly challenging economic, ecological, and social circumstances. The UER employed 5 strategies that facilitated scale up: (1) nurse recruitment from their home districts to improve worker morale and cultural grounding, balanced with some social distance from the village community to ensure client confidentiality, particularly regarding family planning use; (2) prioritization of CHPS planning and continuous review in management meetings to make necessary modifications to the initiative's approach; (3) community engagement and advocacy to local politicians to mobilize resources for financing start-up costs; (4) a shared and consistent vision about CHPS among health administration leaders to ensure appropriate resources and commitment to the initiative; and (5) knowledge exchange visits between new and advanced CHPS implementers to facilitate learning and scale up within and between districts.

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Conflict of interest statement

Competing Interests: None declared

Figures

FIGURE 1.
FIGURE 1.
Phases in the Ghana Program Development Process Source: Reference 14.
FIGURE 2.
FIGURE 2.
Navrongo Experimental Trial Intervention Groups, Kassena-Nankana District, Ghana Source: Reference 32.
FIGURE 3.
FIGURE 3.
Geographic Density of CHPS Coverage by District, Ghana, January 2001 and July 2008 Abbreviations: CHPS, Community-Based Health Planning and Services. Source: Reference 15.
FIGURE 4.
FIGURE 4.
Percentage of the Population Served by Workers of the CHPS Program, by Region and Nationwide, September 2000 to June 2008 Abbreviations: CHPS, Community-Based Health Planning and Services. Source: Reference 15.
See this image and copyright information in PMC

References

    1. Shaw R. P., Elmendorf A. E. Better health in Africa: experiences and lessons learned. Washington, DC: World Bank; 1994
    1. Perry H., Freeman P., Gupta S., Rassekh B. M. How effective is community-based primary health care in improving the health of children? [Internet]. Washington, DC: Community-Based Primary Health Care Working Group, International Health Section, American Public Health Association; 2009 Jul [cited 2012 Dec 1]. 53 p. Available from: http://www.coregroup.org/storage/documents/finalcbphcreport_july2009.pdf
    1. Freeman P., Perry H. B., Gupta S. K., Rassekh B. Accelerating progress in achieving the millennium development goal for children through community-based approaches. Glob Public Health. 2012;7(4), 400–419 - PubMed
    1. Rosato M., Laverack G., Grabman L. H., Tripathy P., Nair N., Mwansambo C., et al. Community participation: lessons for maternal, newborn, and child health. Lancet. 2008;372(9642), 962–971 10.1016/S0140-6736(08)61406-3 - DOI - PubMed
    1. Simmons R., Shiffman J. Scaling-up reproductive health service innovations: a conceptual framework. Simmons R, Fajans P, Ghiron L, editors. Scaling-up health service delivery: from pilot innovations to policies and programmes. Geneva: World Health Organization; 2007 [cited 2012 Dec 1]. Available from: http://whqlibdoc.who.int/publications/2007/9789241563512_eng.pdf

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