Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana

Awoonor-Williams, John Koku; Sory, Elias; Nyonator, Frank; Phillips, James F.; Wang, Chen; Schmitt, Margaret L.

doi:10.9745/ghsp-d-12-00012

Cited by 102 publications

(116 citation statements)

References 25 publications

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“…In addition, implemented interventions to tackle childhood mortality should be reformed based on the recurrent defects identified in policy formulation and implementation to accelerate attainment of SDG 3.2 (9, 31, 34). …”

Section: Discussionmentioning

confidence: 99%

Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs

Kayode

Grobbee

Koduah

et al. 2016

Global Health Action

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BackgroundFollowing the adoption of the Millennium Development Goal 4 (MDG 4) in Ghana to reduce under-five mortality by two-thirds between 1990 and 2015, efforts were made towards its attainment. However, impacts and challenges of implemented intervention programs have not been examined to inform implementation of Sustainable Development Goal 3.2 (SDG 3.2) that seeks to end preventable deaths of newborns and children aged under-five. Thus, this study aimed to compare trends in neonatal, infant, and under-five mortality over two decades and to highlight the impacts and challenges of health policies and intervention programs implemented.DesignGhana Demographic and Health Survey data (1988–2008) were analyzed using trend analysis. Poisson regression analysis was applied to quantify the incidence rate ratio of the trends. Implemented health policies and intervention programs to reduce childhood mortality in Ghana were reviewed to identify their impact and challenges.ResultsSince 1988, the annual average rate of decline in neonatal, infant, and under-five mortality in Ghana was 0.6, 1.0, and 1.2%, respectively. From 1988 to 1989, neonatal, infant, and under-five mortality declined from 48 to 33 per 1,000, 72 to 58 per 1,000, and 108 to 83 per 1,000, respectively, whereas from 1989 to 2008, neonatal mortality increased by 2 per 1,000 while infant and under-five mortality further declined by 6 per 1,000 and 17 per 1,000, respectively. However, the observed declines were not statistically significant except for under-five mortality; thus, the proportion of infant and under-five mortality attributed to neonatal death has increased. Most intervention programs implemented to address childhood mortality seem not to have been implemented comprehensively.ConclusionProgress towards attaining MDG 4 in Ghana was below the targeted rate, particularly for neonatal mortality as most health policies and programs targeted infant and under-five mortality. Implementing neonatal-specific interventions and improving existing programs will be essential to attain SDG 3.2 in Ghana and beyond.

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Section: Discussionmentioning

confidence: 99%

Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs

Kayode

Grobbee

Koduah

et al. 2016

Global Health Action

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“…Subsequent investigations suggest, however, that the health and demographic impact of scaled up operations contrast with the original Navrongo results (Awoonor-Williams et al, 2013;Awoonor-Williams, VaughanSmith, & Phillips, 2010;Binka et al, 2007;Phillips et al, 2006). Although the Project's child mortality effects have been sustained and extended a decade after experimental operations ended, new evidence shows that the effects of the scaled-up programme are now less pronounced .…”

mentioning

confidence: 83%

“…Scale-up began in the original comparison areas of the Navrongo Project, providing opportunities to assess the long-term fidelity to the operational design and its demographic consequences. Monitoring evidence demonstrates that by mid-2008, the proportion of households reached by CHPS coverage in the UER was five times that achieved in other regions (Awoonor-Williams et al, 2013). While this successful expansion of coverage has improved post-infant childhood survival in communities served by CHPS, preliminary analysis suggests the survival of infants has been unaffected (A.…”

mentioning

confidence: 94%

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

Krumholz

Stone

Dalaba

et al. 2014

Global Public Health

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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.

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“…These CHPS compounds have resident Community Health Officers (CHOs) offering door-to-door services to community members (17, 18). There are two community clinics jointly run by the Catholic Diocesan Development Office and the District Health Administration.…”

Section: Methodsmentioning

confidence: 99%

Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

Dalaba

Akweongo

Aborigo

et al. 2014

Global Health Action

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IntroductionThe Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households.ObjectiveTo assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana.MethodsWe conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective.ResultsOf the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330).ConclusionEven though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment.

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Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana

Cited by 102 publications

References 25 publications

Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs

Temporal trends in childhood mortality in Ghana: impacts and challenges of health policies and programs

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

Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

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