PROJECT
Navrongo Community Health and
Family Planning Project

Whether fertility and mortality can be changed by program action in Sahelian West Africa remains a critical issue for population policy. Strategies and programs are sometimes supported by governments and donors without much guidance from primary experimental investigation. Experimental research on critical issues in reproductive and child health is useful, not only for the scientific lessons that emerge, but also for the contribution that it can make to the process of national health policy and program reform.

The Navrongo experiment in northern Ghana has become a case study in the utilization of experimental trials for large-scale program development. The results of a decade of investigation have provided a continuous resource for guiding critical policy decisions, demonstrating success to leaders at all levels in the government, and training district teams to replicate operations throughout the country.

Implementation of the experiment has proceeded in stages, each addressed to successive generations of policy questions. The first phase (1994–96) clarified the design of the experiment and identified means of mobilizing the social institutions of chieftaincy, lineage, and social networks for governing service activities. In 1996, experience gained in the first phase was used to implement a large experiment for testing whether these strategies could have a demographic impact.

The population in the most intensive cell of the experiment experienced a significant long-term fertility decline. After four years, its fertility was 16 percent below levels observed in the absence of project exposure. These differentials are attributable to the impact of outreach services and male mobilization strategies on the continuity of contraception use. In addition, where nurses provided community care, exposure to project services led to a decline in child mortality by nearly 60 percent relative to comparison areas. In contrast, in areas where volunteers were deployed in a manner consistent with international donor and national policy, the project had no effect. These results demonstrate that curative nursing care has a pronounced survival impact. Service strategies designed to reduce costs through volunteer services do not work.

The success of this experiment in reducing fertility and mortality led to a third phase that tests the feasibility of extending the Navrongo model to other areas of Ghana. Results from operations in Navrongo are used to specify the content of new community health service policies nationwide. Implemented by the Ghana Health Service, this program is termed the Community-Based Health Planning and Services (CHPS) initiative. It has entered the planning stage in 105 districts and has been fully implemented in ten.

The phased development of the Navrongo experiment, and the national evidence-based policy it has fostered, represent a paradigm for health and population program development that is relevant to other countries in West Africa. The Navrongo program has become a site for international exchange and dissemination of the Ghana experience to other African countries. Policymakers, health administrators, and service providers travel to Ghana where they work with Navrongo counterparts, witnessing community service operations for the purpose of planning pilots of the Navrongo model in their home countries. An international research program is envisioned that will evaluate the transferability of the Navrongo model to other settings.

---

Population Council researchers

Ayorinde A. Ajayi, James F. Phillips

Non-Council collaborators

Phillip B. Adongo, James Akazili, Patricia Akweongo, Rofina Asuru, Ayaga Agula Bawah, Fred N. Binka, Cornelius Debpuur, Henry V. Doctor, John Williams (Navrongo Health Research Centre, Ghana)

Donors

The William and Flora Hewlett Foundation

The Andrew W. Mellon Foundation

Population Council

US Agency for International Development

---

---