Abstract
BackgroundThe completion of an implementation research project typically signals the end of research. In contrast, the Ghana Health Service has embraced a continuous process of evidence-based programming, wherein each research episode is followed by action and a new program of research that monitors and guides the utilization of lessons learned. This paper reviews the objectives and design of the most recent phase in this process, known as a National Program for Strengthening the Implementation of the Community-based Health Planning and Services (CHPS) Initiative in Ghana (CHPS+).MethodsA mixed method evaluation strategy has been launched involving: i) baseline and endline randomized sample surveys with 247 clusters dispersed in 14 districts of the Northern and Volta Regions to assess the difference in difference effect of stepped wedge differential cluster exposure to CHPS+ activities on childhood survival, ii) a monitoring system to assess the association of changes in service system readiness with CHPS+ interventions, and iii) a program of qualitative systems appraisal to gauge stakeholder perceptions of systems problems, reactions to interventions, and perceptions of change. Integrated survey and monitoring data will permit multi-level longitudinal models of impact; longitudinal QSA data will provide data on the implementation process.DiscussionA process of exchanges, team interaction, and catalytic financing has accelerated the expansion of community-based primary health care in Ghana’s Upper East Region (UER). Using two Northern and two Volta Region districts, the UER systems learning concept will be transferred to counterpart districts where a program of team-based peer training will be instituted. A mixed method research system will be used to assess the impact of this transfer of innovation in collaboration with national and regional program management. This arrangement will generate embedded science that optimizes prospects that results will contribute to national CHPS reform policies and action.
Highlights
The completion of an implementation research project typically signals the end of research
Community-based health planning and services (CHPS) Representing Ghana’s flagship approach to achieving Universal Health Coverage, Ghana’s Community-based Health Planning and Services (CHPS) was launched in 2000 as a program for scaling-up community-based primary health care strategies that had been proven to be effective by an experimental study of the Navrongo Community Health and Family Planning Project [3,4,5]
Evidence from field research showed that implementation had drifted from the original proven package of implementation strategies [10, 11]: National strategies for scaling up CHPS focused on policy pronouncements, workshops, and didactic leadership training, each pursued as isolated activities that lacked systems perspectives
Summary
The completion of an implementation research project typically signals the end of research. Scientists completing work on successful experimental health systems studies often recommend scaling-up results, thereby ending research by handing over lessons learned to policy makers and managers [1]. Community-based health planning and services (CHPS) Representing Ghana’s flagship approach to achieving Universal Health Coverage, Ghana’s Community-based Health Planning and Services (CHPS) was launched in 2000 as a program for scaling-up community-based primary health care strategies that had been proven to be effective by an experimental study of the Navrongo Community Health and Family Planning Project [3,4,5]. University programs, which could bridge leadership gaps by training health specialists, were training health science specialists rather than health systems managers with implementation leadership skills This resulted in a fundamental disconnect between capacity building, policy making, and evidence-generating field stations
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