CHPS moves health services to community locations, develops sustainable volunteerism and community health action, empowers women and vulnerable groups, and improves health provider, household and community interaction. This program had origins in the activities and research findings of the Navrongo Health Research Centre (NHRC) which has conducted a successful field experiment in Kassena-Nankana District of the Upper East Region. The Navrongo experiment tested means of addressing inequities in the health system through mobilization of both health sector and community resources.
Extending the coverage of basic and primary health care services to all Ghanaians has been the major objective of the Ministry since the Alma Ata conference on “Health for All” in 1977. While community-based health service delivery has been viewed as an effective strategy in making basic health services accessible to all Ghanaians, the appropriate means of implementing this goal has been the subject of considerable discussion and debate. The implementation of community-based service delivery in the Kassena-Nankana district demonstrated the feasibility and usefulness of reorienting health care at the periphery, answering the fundamental question of whether health services can be moved out of the clinical setting and whether achieving this actually has an impact. The experiences and lessons of this project have therefore served to reinforce the Ministry’s commitment towards community-based health service delivery, and the Ministry responded to the Navrongo results with a draft policy statement calling for the replication of this approach in other parts of the country.
Ghana Health Service Role
CHPS was moved from an experiment to nationwide implementation in two phases.
The first phase, spanning the 1998 to 2000 period, consisted of dissemination to build consensus in the country and a formal Ministry of Health policy calling for utilization of the Navrongo experiment. During this phase, CHPS was an organic process in which districts were exposed to information on Navrongo in routine MOH meetings. Some district health management teams (DHMT) requested site visits to Navrongo, or conducted exchanges with other districts that had acquired some exposure to the Navrongo system. Regional Health Management Teams encouraged changes in service operations that spontaneously arose from these exchanges.
The second phase focused on implementation (scaling up or replication) in “Innovator Districts” where CHPS demonstration capabilities were developed. Initial work was directed to identifying at least 10 districts dispersed in the 10 Regions of Ghana. The central purpose of these phases was to develop a system of “learning-by-doing” in which the Navrongo model would be reviewed, modified, and pilot tested in other regions. On the basis of the pilot test, a locally adapted service model would be scaled up within the lead district. Thus, the CHPS program has been viewed from the onset less as a means of replicating the Navrongo system than an approach to developing services according to local needs and circumstances. CHPS is therefore a mechanism for fostering decentralization in program planning and management.
- Kassena-Nankana (the Navrongo CHFP experiment)