PROJECT
Policy Development in Ghana

Successful experimental projects often fail to influence what programs actually do. This problem is being addressed by a collaborative program of research by the Policy Research Division and the Ghana Health Service (GHS). Early evidence that the Navrongo experiment reduced childhood mortality and fertility led to a 1999 policy calling for the replication of Navrongo health service strategies throughout Ghana and the creation of the Community-based Health Planning and Services (CHPS) initiative. District managers were instructed to reorganize clinical health and family planning services into decentralized community-based and -led programs. In response to evidence that CHPS implementation required more than dissemination of the Navrongo results, the GHS developed a program of field exchanges designed to foster the diffusion of organizational change. Research tools have been developed to monitor the diffusion process.

Ongoing scaling-up activities in Ghana include annual national health policy conferences, field exchanges, newsletters, and other activities designed to exchange information about the program among district health management teams. A series of surveys, conducted in collaboration with Population Council staff members, are showing that the Navrongo model has a major health and family planning impact in lead districts throughout Ghana. Data collection and reporting systems have been developed for monitoring the pace and geographic coverage of CHPS, the operational and social constraints to program progress, and program impact on health and family planning behavior. Focus group studies, survey research, and quantitative methods assess determinants of organizational behavior, leadership, consensus, and action. CHPS tools will demonstrate an approach to developing health and family planning service systems and policies in resource-constrained settings elsewhere in Africa.

The Council's Policy Research Division has launched a collaboration with the World Health Organization and the University of Michigan to establish an international research network for developing research tools for the study of problems in organizational change and development. A series of World Health Organization publications, currently in press, will describe the goals and methods of the CHPS initiative and document the organizational theories and principles on which it is based. Experience gained in Ghana will become a resource for designing scaling-up programs and improving the use of evidence in health sector reform.

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Population Council researchers

Ayorinde A. Ajayi, James F. Phillips, Delanyo Dovlo, Adams Kasanga, Robert A. Miller, Philomena Nyarko

Non-Council collaborators

Sam Adjei, Agyemang Badu Akosa, J. Koku Awoonor-Williams, Frank K. Nyonator (Ghana Health Service)

Donors

The William and Flora Hewlett Foundation

The Andrew W. Mellon Foundation

Population Council

The Rockefeller Foundation

US Agency for International Development

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