The bumpy road to better health: How embedded research strengthened health services in Ghana
Ghana’s success story
For over 20 years, Ghana’s CHPS programme has been the focus of the country’s primary health care strategy. It’s a community-centred approach that has transformed maternal and child health in the most inaccessible parts of the country. But how did it come into being, and what has Ghana done differently that has made it so successful? Community-based Health Planning and Services – more commonly referred to by its acronym CHPS (pronounced ‘chips’) – is well known by health systems experts across the world. In rural areas, CHPS is often the first point of contact with government health services. As in many other low- and middle-income countries, Ghana experiences a great number of impediments to improving health and well-being for its citizens. Many people live long distances from the nearest health centre. Access to electricity, mobile-cellular coverage and clean water are a challenge in rural areas. While international standards suggest that the ideal ratio is one doctor per 1 000 people, in Ghana in 2017 there was only one doctor per 8 098 people, and most of these doctors lived in cities and towns. In addition to logistical challenges, there are also local cultural beliefs preventing women from seeking care, even during childbirth.
The bumpy road to better health: How embedded research strengthened health services in Ghana is the story of how an experiment in the north of Ghana changed the health of a nation. How health staff in remote and rural areas are working tirelessly to prevent the deaths of mothers and children. How a radical approach to health research, known as embedded research, has revolutionized how the government delivers health services under difficult circumstances.
Five steps Ghana took to infuse evidence into its primary health care system
Step 1: Believe in research
Step 2: Get everyone around the table
Build a shared agenda for change.
Successful embedded research projects bring everyone together – researchers, implementers and policy-makers – from the very beginning. In Ghana, the roll out of the CHPS programme also involved directly engaging communities. Input from development partners was also helpful. Agreeing on the questions to be asked, the methods to be used and who is to be involved was critical for moving forward together.
Step 3: Communicate regularly
Share data and intelligence as it becomes available.
It has been important in Ghana to share information about what is being revealed while the research is underway. This active sharing has allowed for adjustments to programmes based on new knowledge and for researchers to respond to emerging policy or implementation priorities. For example, in one of the CHPS study areas, some asides made during focus group discussions highlighted that lower-level staff in the health facilities felt that their supervision was too stern and not supportive. The district director was able to swiftly address the issue, holding human resource management training on addressing conflict and conducting monitoring visits. Observing and reacting to new information can have real impacts for those working on the frontline of health.
Step 4: Think local
Research should respond to real-world challenges. Embedded research needs to respond to the problems and challenges that are being faced by policy-makers and health staff on the frontlines. In Ghana, one way they ensured this was through establishing partnerships with local research institutions and not just relying on national or international experts.
Step 5: Keep going
Always build on success. In Ghana, they built on findings from an experiment to create a primary health care system that is addressing the needs of its rural communities. But the scale-up process was not easy and required continued research to support innovations and get the programme back on the right road. Even where the programme is working well, embedded research is helping it to evolve and to respond to changing needs within communities.