Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Study protocol

What do you do with success? The science of scaling up a health systems strengthening intervention in Ghana

Authors: James F. Phillips, John Koku Awoonor-Williams, Ayaga A. Bawah, Belinda Afriyie Nimako, Nicholas S. Kanlisi, Mallory C. Sheff, Patrick O. Asuming, Pearl E. Kyei, Adriana Biney, Elizabeth F. Jackson

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

The 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+).

Methods

A 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.

Discussion

A 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.
Literature
1.
2.
Awoonor-Williams JK, Phillips JF, Bawah AA. The application of embedded implementation science to developing community-based primary health care in Ghana. International Journal for Population. Dev Health. 2017;1(1):66–81.
3.
Binka FN, Bawah AA, Phillips JF, Hodgson A, Adjuik MA, MacLeod BB. Rapid achievement of the child survival Millennium Development Goal. Evidence from the Navrongo Experiment in northern Ghana. Trop Med Int Health. 2007;12(5):578–93.
4.
5.
Nyonator FK. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20(1):25–34.CrossRefPubMed
6.
Awoonor-Williams JK, Vaughan-Smith MN, Phillips JF. Scaling-up health system innovations at the community level: A case study of the Ghana experience. In: Malarcher S, editor. Social Determinants of Sexual and Reproductive Health: Informing Future Research and Programme Implementation. Geneva: The World Health Organization; 2010. p. 51–70.
7.
Awoonor-Williams JK, et al. Bridging the gap between evidence-based innovation and national health-sector reform in Ghana. Stud Fam Plan. 2004;35(3):161–77.CrossRef
8.
Awoonor-Williams JK, Phillips JF, Bawah AA. Catalyzing the scale-up of community-based primary healthcare in a rural impoverished region of northern Ghana. Int J Health Plann Manag. 2016;31(4):e273–89.CrossRef
9.
F. K. Nyonator, J. K. Awoonor-Williams, and J. F. Phillips, Scaling down to scale-up: accelerating the expansion of coverage of community-based health Services in Ghana. 2011.
10.
11.
Krumholz AR, Stone AE, Dalaba MA, Phillips JF, Adongo PB. Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: management perspectives from northern Ghana. Glob Public Health. 2015;10(3):366–78.CrossRefPubMed
12.
Awoonor-Williams JK, et al. The Ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC Health Serv Res. 2013;13(Suppl 2):S3.CrossRefPubMedPubMedCentral
13.
Phillips, JF, Binka FN, Bawah AA. Accelerating reproductive and child health programme impact with community-based services: the Navrongo experiment in Ghana. Bull World Health Organ. 2006;85(12):949–54.
14.
Katz D, Kahn RL. The Social Psychology of Organizations, second edition. Hoboken, New Jersey: John Wiley and Sons; 1978.
15.
Dalton GW, Lawrence PR. Organizational Change and Development. Burr Ridge, Illinois: Richard D. Irwin, Inc.; 1970.
16.
Lawrence PR, Lorsch JW. Developing Organizations: Diagnosis and Action. Reading, Massachusetts: Addison-Wesley, Inc; 1969.
17.
Phillips JF, Sheff M, Boyer CB. The astronomy of Africa’s health systems literature during the MDG era: where are the systems clusters? Glob Heal Sci Pract. 2015;3(3):482–502.CrossRef
18.
Awoonor-Williams JK, Vaughan-Smith MN, Phillips JF. “Scaling-up health system innovations at the community level: A case study of the Ghana experience” in Malarcher S. (ed.) Social Determinants of Sexual and Reproductive Health: Informing Future Research and Programme Implementation. Geneva: World Health Organization; 2010. p. 51-70.
19.
Fajans P, Simmons R, Ghiron L. Helping public sector health systems innovate: the strategic approach to strengthening reproductive health policies and programs. Am J Public Health. 2006;96(3):435–40.CrossRefPubMedPubMedCentral
20.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.CrossRefPubMedPubMedCentral
21.
DeSavigny D, Adam T. Systems Thinking for Health Systems Strengthening. Geneva: Alliance for Health Policy and Systems Research, Wolrd health Organization; 2009.
22.
Mutale W, Chintu N, Amoroso C, Awoonor-Williams JK, Phillips JF, Baynes CD, Michel C, Taylor A, Sherr K. Improving health information systems for decision making across five sub-Saharan African countries: implementation strategies from the African health initiative. BMC Health Serv Res. 2013;13(Suppl 2:S9). https://​doi.​org/​10.​1186/​1472-6963-13-S2-S9.
23.
24.
Asuo-Mante E, Mumuni AJ, Asuo-Mante M, Yelifari L, Phillips JF. “A pilot trial of applying geographic information system technology to health system strengthening in the Upper East Region of Ghana.” J BMC Med Inform Decis Mak. 2017;1(1):1–9.
25.
Asuo-Mante E, Awoonor-Williams JK, Yelifari L, Boyer C, Schmitt ML, Phillips JF. The application of geographic information systems (GIS) to improving health systems in the Upper East Region of Ghana. J Global Health Care Syst. 2017;6(1):1–14.
26.
Simmons R, Shiffman J. Scaling up health service innovations: a framework for action in Simmons R, Fajans P, Ghiron L (eds.). Scaling Up Health Service Delivery: From Pilot Innovations to Policies and Programmes. Geneva: World Health Organization; 2007 p.1-30.
27.
Ghiron L, et al. Beginning with sustainable scale up in mind: initial results from a population, health and environment project in East Africa. Reprod Health Matters. 2014;22(43):84–92.CrossRefPubMed
28.
Simmons R, Hall P, Diaz J, Diaz M, Fajans P, Satia J. The strategic approach to contraceptive introduction. Stud Fam Plan. 1997;28(2):79–94.CrossRef
29.
Simmons R, Brown J, Díaz M. Facilitating large-scale transitions to quality of care: an idea whose time has come. Stud Fam Plan. 2002;33:61–75.CrossRef
30.
31.
M. O’Reilly-de Brún et al., Using Participatory Learning & Action research to access and engage with ‘hard to reach’ migrants in primary healthcare research. BMC Health Serv. Res, vol. 16, no. 1, p. 25, 2016.
32.
Leung MW, Yen IH, Minkler M. Community based participatory research: a promising approach for increasing epidemiology’s relevance in the 21st century. Int J Epidemiol. 2004;33:499–506.CrossRefPubMed
33.
Brieger WR, Ramakrishna J, Akpovi SU. Organizational development as a health education strategy to maintain community involvement in PHC Managemen. Int. Q. Community Health Educ. 1988;8(4):351–74.CrossRef
34.
Gilson L, Hanson K, Sheikh K, Agyepong I, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8(8):e1001079.CrossRefPubMedPubMedCentral
35.
Sheikh K, George A, Gilson L. People-centred science: strengthening the practice of health policy and systems research: Health Research policy and systems. Heal Res policy Syst. 2014;12–19(1):19.CrossRef
36.
Nazzar A, Adongo PB, Binka FN, Phillips JF, Debpuur C. Developing a culturally appropriate family planning program for the Navrongo experiment. Stud Fam Plan. 1995;26(6):307–24.
37.
P. B. Adongo et al., If you do vasectomy and come back here weak, I will divorce you’: a qualitative study of community perceptions about vasectomy in Southern Ghana. BMC Int Health Hum Rights, vol. 14, no. 1, p. 16, 2014.
38.
Adongo PB, et al. The role of community-based health planning and services strategy in involving males in the provision of family planning services: a qualitative study in southern Ghana. Reprod Health. 2013;10(1):1–15.CrossRef
39.
Dalaba MA, Stone AE, Krumholz AR, Oduro AR, Phillips JF, Adongo PB. A qualitative analysis of the effect of a community-based primary health care programme on reproductive preferences and contraceptive use among the Kassena-Nankana of northern Ghana. BMC Health Serv Res. 2016. https://​doi.​org/​10.​1186/​s12913-016-1325-6.
40.
Nyonator FK, Jones TC, Miller RA, Phillips JF, Awoonor-Williams JK. Guiding the Ghana community-based health planning and services approach to scaling up with qualitative systems appraisal. Int Q Community Health Educ. 2005;23(3):189–213.CrossRef
41.
42.
Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF International. Ghana Demographic and Health Survey 2014. Rockville: ICF International. 2015.
43.
Spybrook J, Bloom H, Congdon H, Hill C, Martinez A, Raudenbush S. Optimal Design Plus Empirical Evidence: Documentation for the ‘Optimal Design’ Software. New York: William T. Grant Foundation; 2011.
44.
Dimick JB, Ryan AM. Methods for evaluating changes in health care policy: the difference-in-differences approach. J Am Med Assoc. 2014;312(22):2401–2.CrossRef
45.
T. Conley and C. Taber, Inference with ‘difference in differences’ with a small number of policy changes. 2005.CrossRef
46.
Donald SG, Lang K. Inference with difference-in-differences and other panel data. Rev Econ Stat. 2007;89(2):221–33.CrossRef
47.
Bawah AA, et al. The child survival impact of the Ghana essential health interventions program: a health systems strengthening initiative in a rural region of northern Ghana. In: Annual meeting of the population Association of America; 2017.
48.
Frimpong JA, Helleringer S, Awoonor-Williams JK, Yeji F, Phillips JF. Does supervision improve health worker productivity? Evidence from the upper east region of Ghana. Trop Med Int Heal TM IH. 2011;16:1225–33.CrossRef
49.
Atinga RA, Agyepong IA, Esena RK. Ghana’s community-based primary health care: why women and children are ‘disadvantaged’ by its implementation. Soc Sci Med. 2018;201:27–34.CrossRefPubMed
50.
Ghaffar A, et al. Changing mindsets in health policy and systems research. Lancet. 2013;381(9865):436–7.CrossRefPubMed
51.
Ghaffar A, Langlois EV, Rasanathan K, Peterson S, Adedokun L, Tran NT. Strengthening health systems through embedded research. Bull World Heal Organ. 2017;95:87.CrossRef
52.
Perry H, et al. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. Strategies used by effective projects. J Glob Health. 2017;7(1):010906.CrossRefPubMedPubMedCentral
53.
Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Mushtaque A, Chowdhury R, Kirkwood BR, Kureshy N, Lanata CF, Phillips JF, Taylor M, Victora CG, Zhu Z. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. Summary and recommendations of the expert panel. J Glob Health. 2017;7(1):010908. https://​doi.​org/​10.​7189/​jogh.​07.​010908.
54.
Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399–421.CrossRefPubMed
55.
Singh P, Sachs JD. 1 million community health workers in sub-Saharan Africa by 2015. Lancet. 2013;382(9889):363–5.CrossRefPubMed
56.
Haines A, et al. Achieving child survival goals: potential contribution of community health workers. Lancet. 2007;369(9579):2121–31.CrossRefPubMed
Metadata
Title
What do you do with success? The science of scaling up a health systems strengthening intervention in Ghana
Authors
James F. Phillips
John Koku Awoonor-Williams
Ayaga A. Bawah
Belinda Afriyie Nimako
Nicholas S. Kanlisi
Mallory C. Sheff
Patrick O. Asuming
Pearl E. Kyei
Adriana Biney
Elizabeth F. Jackson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3250-3

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Risk perception of blood transfusions – a comparison of patients and allied healthcare professionals

Research article

Barriers and facilitators to the integration of depression services in primary care in Vietnam: a mixed methods study

Research article

Supporting the implementation of stroke quality-based procedures (QBPs): a mixed methods evaluation to identify knowledge translation activities, knowledge translation interventions, and determinants of implementation across Ontario

Research article

The prevalence and clinical seriousness of medication discrepancies identified upon hospital admission of pediatric patients

Research article

Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach

Research article

Sexual and reproductive healthcare for women asylum seekers in Switzerland: a multi-method evaluation