ABSTRACT

Phillips, James F., Ayaga A. Bawah, and Fred N. Binka. 2006. "Accelerating reproductive and child health programme impact with community-based services: The Navrongo experiment in Ghana," Bulletin of the World Health Organization 84(12): 949–953.

Objective
To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results.

Methods
A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life. Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality.

Results
Assigning nurses to community locations reduced childhood mortality rates by over half in three years and accelerated the time taken for attainment of the child survival Millennium Development Goal (MDG) in the study areas to six years. Fertility was also reduced by 15 percent, representing a decline of one birth in the total fertility rate. Program costs added US$1.92 per capita to the US$6.80 per capita primary health care budget.

Conclusion
Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress toward attainment of the child survival MDGs. Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs.

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