Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: Management perspectives from northern Ghana

Abstract

From 1994 to 2003, the government of Ghana investigated the child survival and fertility impacts of community-based primary care nurses and volunteer mobilisation efforts. This study, known as the Navrongo Project, demonstrated improved health outcomes and was scaled-up as the Community-based Health Planning and Services (CHPS) Initiative. Studies suggest that scaled-up CHPS services have not fully replicated the impact of the Project. This study investigates implementation challenges that could explain this atrophy by assembling the perspectives of health care managers that have experience with both the Project and CHPS. Data from in-depth interviews of health managers are analysed using deductive content analysis. Respondents exhibited a consistent vision of doorstep services with regard to the Project and CHPS. They shared the perspective that while scale-up has progressed slowly, it has expanded the range of services provided. Respondents felt, however, that the original emphasis on community involvement has atrophied with scale-up and that current operations are managed less rigorously than during the Project. Thus, while the expanded scope of CHPS has increased access to health care, the original focus on community engagement has faded. The original Project leadership strategy merits review for ways to integrate leadership development into scale-up activities.

Keywords:

• community health
• scaling up
• implementation research

Notes

1. The study was approved in June 2012 by the Institutional Review Board for the Protection of Human Subjects at Columbia-Presbyterian Medical Center in New York, as well as that of the Navrongo Health Research Centre in Ghana. All study participants were informed of the study purpose and provided informed consent prior to the interview. Although participants were not monetarily compensated for their involvement, they were provided with refreshments as a token of thanks.

Additional information

Funding

This publication was prepared under a Subaward funded by Family Health International under a Cooperative Agreement [grant number GPO-A-00-08-00001-00] funded by USAID. The content of this publication does not necessarily reflect the views, analysis or policies of FHI 360 or USAID, nor does any mention of trade names, commercial products or organisations imply endorsements by FHI 360 or USAID. Support for Ghana Essential Health Intervention Programme activities in the UER is provided by [grant number DDCF2009058B] to Columbia University from the Doris Duke Charitable Foundation.