Community-based health planning and services initiative in Ghana: A paradigm for evidence-based health systems development

The 130th Annual Meeting of APHA

5156.0: Wednesday, November 13, 2002 - 3:00 PM

Abstract #43538

Frank K. Nyonator, MD, MPH¹, John K. Awoonor-Williams, MD, MPH², James Phillips, PhD³, Tanya C. Jones, MPA³, and Robert A. Miller, DrPH⁴. (1) Director, Volta Regional Health Administration, Ghana Ministry of Health, P.O. Box 72, Ho, Volta Region, Ghana, 233-91-28211, nyonator@africaonline.com.gh, (2) District Director, Nwkanta District Health Administration, Ghana Health Service, P.O. Box 54, Nkwanta, Volta Region, Ghana, (3) Policy Research Division, Population Council, 1 Dag Hammarskjold Plaza, New York, NY 10017, (4) Senior Associate, International Programs Division, Population Council, 1 Dag Hamarskjold Plaza, New York, NY 10017

Research projects throughout the developing world often demonstrate ways to improve health services. Yet, scientific evidence often has little bearing on what programs actually do. An approach to evidence-based policy development has been launched in Ghana that bridges the gap between research and policy by using a successful experimental study as a model for national health systems reform. Guided by organizational theory, the Community-based Health Planning and Services (CHPS) initiative includes field demonstrations that foster the diffusion of innovation and conferences and training activities for catalyzing planned operational change.

In all, 66 districts out of the 110 districts in Ghana have started translating lessons from the Navrongo Community Health and Family Planning Project into locally adapted approaches to community health services. Despite progress, there is ample evidence of constraints to rapid operational change. At the periphery, resources for logistics and construction slow the process of posting community health nurses to village locations. Centrally, structural problems in the national health care system limit capacities to coordinate a reform program. Nonetheless, the progress achieved is impressive in light of the institutional and resource barriers to reorienting care.

The CHPS initiative represents a model for health reform in settings where severe resource constraints hinder planned organizational change. By building experience from community research, CHPS demonstrates ways to mobilize volunteerism and local resources that would not otherwise be resources for primary health care. The project represents a paradigm for health care development that may be relevant to health ministries elsewhere in Africa.

Learning Objectives:

Step 1

The presentation will expose the audience to a new paradigm for health systems development in Africa and introduce new perspectives on theories and practices of organizational development in large-scale public sector health service systems.
Step 2
- The presentation will enable participants to review scientific literature and design studies for guiding the development of large-scale organizations with information gained in experimental studies.
- Step 3
  - At the conclusion of the session, participants will be able to
    - Discuss the experience of a successful health service scaling-up effort in sub-Saharan and assess its possible relevance to the utilization of small-scale innovation elsewhere in Africa.
    Keywords: Community-Based Health Care, Community Health Planning
    Presenting author's disclosure statement:
    I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
    
    Methodology and Needs Assessment in the Developing World and Abroad
    The 130th Annual Meeting of APHA