For two decades, the Ghana Ministry of Health placed priority on community-based primary health care and family planning services. National programs were launched for deploying volunteers and community health nurses to communities, but by 1992 it was evident that the programs were not functioning as planned. Volunteers were inadequately supervised and the quality of service was poor. While 2,000 nurses had been hired, trained, and deployed to subdistrict clinics, the care offered at the clinics was inaccessible to most rural families. In 1994, the Ghana Ministry of Health established the Navrongo Health Research Centre in northeastern Ghana to improve access to reproductive and child health services in impoverished communities. By 1996, differing strategies were being tested to determine how best to launch and sustain community health services: services provided by community-based nurses working alone, volunteers working alone, and nurses and volunteers working together. Conventional Ministry of Health clinical services were also provided in all areas of the study district, including those not receiving resident nurse or volunteer care. Strategies for training and community involvement were designed to improve the quality of volunteer services. Engaging community members in construction and support of facilities to house care providers enabled the project to relocate nurses to the communities and sustain accessible care at low cost. In communities where nurses were deployed, mortality rates under age five dropped by 50 percent in three years. Adding volunteers to this strategy improved family planning acceptability and reduced fertility by 15 percent. These results prompted adoption of a combined community-nurse and volunteer-outreach strategy as the model for national policy. As an advisor to the Ghana Health Service, James Phillips, a Council senior research associate, is bridging the gap between research results and their practical application, including how best to build consensus for health service reforms at the national, regional, and community levels. “The government of Ghana wanted to find ways of solving the service quality and accessibility problems,” says Phillips. “But, given past problems with poorly planned, large-scale programs, they wanted to focus attention on launching a trial that could guide development of their health-care delivery system.” Replication of the Navrongo model in the Nkwanta District was launched in 2000 to test the transfer of lessons learned to a nonresearch setting. This project demonstrated that the Navrongo approach to service delivery was replicable as long as accommodation was made for differences in prevailing customs and resources. The emphasis on what worked and what failed (see right) made successful scale-up possible. On the basis of those results, the Ministry of Health adopted the Navrongo model as an integral component of its national poverty-reduction strategy. In 2000 the Ghana Health Service launched the Community-based Health Planning and Services (CHPS) initiative, with Phillips serving as advisor. CHPS mobilizes volunteers, resources, and cultural institutions to support delivery of community-based, primary health-care services throughout Ghana. CHPS has been fully implemented in 20 communities within Ghana’s 138 districts. In September, Phillips and Council Berelson Fellow Ayaga Bawah presented findings from the CHPS initiative to senior officials of the United States Agency for International Development (USAID), which recently awarded the Council a five-year grant to assist the Ghanaian Government in the scale-up of the Navrongo model. The presentation, entitled “The design, impact, and utilization of the Navrongo Experiment in Northern Ghana,” is set for publication in the Population Council Working Paper series. n The Council’s work in Ghana is funded by The William and Flora Hewlett Foundation, The Andrew W. Mellon Foundation, and USAID.(Return to issue contents)
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