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. 2021 Jun 22;6(1):e10282.
doi: 10.1002/lrh2.10282. eCollection 2022 Jan.

Developing organizational learning for scaling-up community-based primary health care in Ghana

John Koku Awoonor-Williams  1 , James F Phillips  2
Affiliations

Developing organizational learning for scaling-up community-based primary health care in Ghana

John Koku Awoonor-Williams et al. Learn Health Syst. .

Abstract

Introduction: Achieving effective community-based primary health care requires evidence for guiding strategic decisions that must be made. However, research processes often limit data collection to particular organizational levels or disseminate results to specific audiences. Decision-making that emerges can fail to account for the contrasting perspectives and needs of managers at each organizational level. The Ghana Health Service (GHS) addressed this problem with a multilevel and sequential research and action approach that has provided two decades of implementation learning for guiding community-based primary health care development.

Method: The GHS implementation research initiatives progressed from (i) a participatory pilot investigation to (ii) an experimental trial of strategies that emerged to (iii) replication research for testing scale-up, culminating in (iv) evidence-based scale-up of a national community-based primary health care program. A reform process subsequently repeated this sequence in a manner that involved stakeholders at the community, sub-district, district, and regional levels of the system. The conduct, interpretation, and dissemination of results that emerged comprised a strategy for achieving systems learning by conducting investigations in phases in conjunction with bottom-up knowledge capture, lateral exchanges for fostering peer learning at each system level, and top-down processes for communicating results as policy. Continuous accumulation of qualitative data on stakeholder reactions to operations at each organizational level was conducted in conjunction with quantitative monitoring of field operations.

Results: Implementation policies were enhanced by results associated with each phase. A quasi-experiment for testing the reform process showed that scale-up of community-based primary health care was accelerated, leading to improvements in childhood survival and reduced fertility.

Conclusion: Challenges to system learning were overcome despite severe resource constraints. The integration of knowledge generation with ongoing management processes institutionalized learning for achieving evidence-driven program action.

Keywords: Community‐based Health Planning and Services; Ghana; community‐based primary health care; health systems strengthening; learning health system; research utilization; scaling‐up.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
The phases of research associated with Community‐based Health Planning and Services (CHPS) development and reform
FIGURE 2
FIGURE 2
The population density of Community‐based Health Planning and Services (CHPS) implementation coverage by district of Ghana, December 2008
FIGURE 3
FIGURE 3
The health sector knowledge management system at the onset Navrongo Health Research Centre (NHRC) research operations
FIGURE 4
FIGURE 4
Proportion of total populations of Ghana Essential Health Interventions Program (GEHIP) treatment and comparison areas residing in zones where Community‐based Health Planning and Services (CHPS) is functioning, Upper East Region, 2006–2015
FIGURE 5
FIGURE 5
The Ghana Essential Health Interventions Program (GEHIP) knowledge management system
See this image and copyright information in PMC

References

    1. World Health Organization . Alma Ata Declaration. Geneva, Switzerland; 1978.
    1. Ghana Health Service . The Community‐Based Health Planning and Services (CHPS) Initiative. Accra, Ghana; 1999.
    1. Ghana Health Service . National Community‐Based Health Planning and Services Policy: Accelerating Attainment of Universal Health Coverage and Bridging the Access Equity Gap. Accra, Ghana; 2016.
    1. Phillips JF, Binka FN, Awoonor‐Williams JK, Bawah AA. Four decades of community‐based primary health care development in Ghana. In: Bisha D, Schleiff M, eds. Health for All – Success Stories from Countries that Transformed People's Health: Essays to Recognize the 40th Anniversary of the Alma Ata Conference. Baltimore, MD: Johns Hopkins University Press; 2020:225‐257. https://www.google.com/books/edition/Achieving_Health_for_All/Ofn4DwAAQB....
    1. Nyonator FK, Awoonor‐Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community‐based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20(1):25‐34. 10.1093/heapol/czi003. - DOI - PubMed

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