The Ghana Community-based Health Planning and Services Initiative: Fostering evidence-based organizational change and development in a resource-constrained setting

Abstract

Research projects throughout the developing world often demonstrate ways to improve health services. Yet scientific evidence often has little bearing on what large scale national health programs actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research findings and programme implementation. Guided by open systems organizational theory the Community-based Health Planning and Services (CHPS) initiative employs a successful experimental study as a model for national health systems reform and implements a national strategy for fostering the diffusion of innovation and planned operational change. Over a two year period 71 districts out of the 110 districts in Ghana have started the CHPS programme suggesting that CHPS has fostered the rapid diffusion of organizational change. This paper reviews features of the CHPS initiative that build experience from community research and disseminate lessons learned through a programme of dissemination and exchange. CHPS demonstrates ways to mobilize volunteerism local resources and cultural institutions that would not otherwise be resources for primary health care. The CHPS approach thereby represents a paradigm for health care development that may be generally relevant to resource constrained health ministries elsewhere in Africa. Nonetheless limitations of the programme have detracted from its full potential. These problems and their policy implications are reviewed and discussed. (author’s)