Does expanding community-based primary health care coverage also address unmet need for family planning and improve program impact? Findings from a plausibility trial in northern Ghana

Abstract

Background The core strategy for achieving universal health coverage (UHC) in Ghana concerns the goal of expanding access to primary health services to all rural households through an initiative known as Community-based Health Planning and Services (CHPS). To test means of accelerating CHPS implementation, a 5-year primary health system strengthening trial was launched in 2010 that was known as the Ghana Essential Health Interventions Program (GEHIP). Fielded in 4 rural northern districts with 7 comparison districts, GEHIP achieved total CHPS coverage in 4 years, thereby expanding access to community nursing care for the treatment of childhood illness, the provision of immunizations, and promotion and delivery of family planning services. Methods The impact of UHC achievement on contraceptive use and unmet need is assessed with a 2 stage random sample of reproductive-aged women residing in treatment and comparison districts at the GEHIP baseline and end line. A difference-in-differences (DIDs) regression model is employed to estimate the average GEHIP treatment effect on the use of modern contraceptives and unmet need for contraception. Results After controlling for maternal age, children ever born, education, religion, ethnicity, and occupation, regression results show that the GEHIP program had a significant DID effect on modern contraceptive use (odds ratio [OR],1.795; 95% confidence interval, 1.320–2.439) but no effect on unmet need for contraception. Conclusion Expanding access to community-based primary health care improved contraceptive use, but was insufficient for reducing unmet need. Possible implications for supplementing community-based primary health care with family planning focused social mobilization are reviewed.