Scaling Up Field-Trial Success to National Policy Initiative in Ghana: Reviewing a Decade of the Community-based Health Planning and Services Program

In the 1990s the Ghana Ministry of Health assessed the relative effectiveness of workforce strategies to reduce fertility and maternal and child mortality levels. When this demonstrated the success of combining programs that relocate primary healthcare nurses to villages and mobilizes community-volunteerism, this approach, Community-based Health Planning and Services (CHPS), became the national policy. CHPS relocates nurses to village ‘CHPS Zones'; engages traditional institutions in service-delivery, and builds capacity to implement CHPS at management and community levels. It produces replicable service-delivery capabilities and mechanisms to filter down use of findings and implementation locally. CHPS has been scaled up to 10 percent of Ghanaian households, but in Ghana's poorest region, the Upper East, CHPS coverage is 50 percent, placing CHPS-districts on target to achieve MDGs 4 and 5. This presentation explains why CHPS has succeeded in the Upper East and proffers a framework for effective policy development and scaling-up. CHPS responds to cultural and workforce-related constraints to health programming with evidence-based planning and community integration. This presentation describes the research that has driven CHPS from pilot to program expansion and discusses how advocacy has grown consensus for CHPS and capabilities to scale it up, catalyzing community-based planning, clinical service and management that improves governance, resource development and volunteerism. It outlines future CHPS goals and the research and action agenda required for realizing them. CHPS has brought impoverished villages to the forefront of health development in Ghana, showing how policy initiatives create scalable mechanisms to increase health equity and achieve population-level impact.