Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 May 10;14(5):e0216589.
doi: 10.1371/journal.pone.0216589. eCollection 2019.

Can a standards-based approach improve access to and quality of primary health care? Findings from an end-of-project evaluation in Ghana

Christina Maly  1 , Richard Okyere Boadu  2 , Carina Rosado  3 , Aliza Lailari  4 , Bernard Vikpeh-Lartey  5 , Chantelle Allen  6
Affiliations
Comparative Study

Can a standards-based approach improve access to and quality of primary health care? Findings from an end-of-project evaluation in Ghana

Christina Maly et al. PLoS One. .

Abstract

Background: Jhpiego implemented a 5-year project to strengthen the Community-Based Health Planning and Services (CHPS) model in six coastal districts of Ghana's Western Region. The project utilized a quality improvement approach (Standards-Based Management and Recognition [SBM-R]) to strengthen implementation fidelity of the CHPS model. This article presents findings from an end-of-project evaluation comparing quality, access to care, and experience of care in intervention and comparison CHPS zones.

Methods: A non-equivalent, posttest-only, end-of-project evaluation compared 12 randomly selected intervention zones with 12 matched comparison zones. Data from standards-based assessments measured provision of care in three categories: community engagement, clinical services, and facility readiness and management. Access to and experience of care were assessed using a household survey of 426 randomly selected community members from the selected CHPS zones. Bivariate and multivariate analyses were conducted to compare performance on these measures between intervention and comparison CHPS zones.

Results: Overall, intervention zones outperformed comparison zones on achievement of standards (83.6% vs 58.8%) across all three assessment categories, with strongest results in community engagement (85.7% vs. 41.4%). Respondents in intervention zones were more than twice as likely to have received a home visit from a community health officer, three times as likely to have a home visit from a community health volunteer, and more likely to have attended a health talk (41.9% vs. 27.0%). Client experiences of care were reported as positive in both study arms.

Conclusions: The evaluation demonstrated improved access to quality care; however, there were very few differences in client experience of care between intervention and comparison zones. As Ghana and other countries are committed to scaling up universal health care, a pragmatic approach such as SBM-R could prove useful to engage both facility- and community-based service providers, as well as community members, to improve provision of care.

PubMed Disclaimer

Conflict of interest statement

Please note this study was funded by Jubilee Partners as part of the overall project award; the funding agency did not have a role in the study design, data collection, analysis or the decision to submit for publication. The funding does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. STAR CHPS project design.
See this image and copyright information in PMC

References

    1. Lawson HJO, Essuman A. Country profile on family medicine and primary health care in Ghana. Afr J Prim Health Care Fam Med. 2016;8(1):1302 10.4102/phcfm.v8i1.1302 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125262/ - DOI - PMC - PubMed
    1. World Bank. Data: World Bank Country and Lending Groups—Country Classification. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-b... Cited 5 Jul 2017.
    1. World Health Organization (WHO). Maternal mortality in 1990–2015. WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division. Maternal Mortality Estimation Inter-Agency Group; Ghana. Available from: http://www.who.int/gho/maternal_health/countries/gha.pdf Cited 5 Jul 2017.
    1. UNICEF. The State of the World's Children 2016: A fair chance for every child. New York: UNICEF; 2016. https://www.unicef.org/publications/files/UNICEF_SOWC_2016.pdf
    1. UNDP. Ghana Millennium Development Goals: 2015 Report. Available from: http://www.gh.undp.org/content/ghana/en/home/library/poverty/2015-ghana-... Cited 12 Jul 2017.

Publication types