History:

Prior to the implementation of CHPS in the mid-1990s, there were large geographic disparities in access to health care in Ghana, with 70% of Ghanaians living over 8 km from a provider.1 Clinical indicators were also concerning. Life expectancy was 57 years, total fertility rate was 5.6 births, contraceptive prevalence was 17%, and the under-5 mortality rate was 127 per 1000 live births.

What is empanelment?

Empanelment is the active assignment of patients to a provider or care team. In Ghana, empanelment was determined by geography, and care teams are assigned to groups of 4500 – 5000 individuals. Empanelment can help providers or care teams determine the needs of their population and deliver services accordingly.

How population health management was integrated into health reform:

A small pilot of the Community Health Planning and Strategy (CHPS) program began in 1990 in Navrongo, Kassena-Nankana District. This program was designed to reorient care to the community level through geographic empanelment of care teams to approximately 4500-5000 individuals. Clinical nurses known as community health officers (CHOs) delivered community-based care to their panel through proactive population outreach during home visits. CHOs’ work was supplemented by trained volunteers who provided services such as oral rehydration, family planning, and support for CHOs in immunization and antenatal care.3 The pilot program was planned as a quasi-experimental study and was found to be successful; the total fertility rate in the region decreased by one birth, knowledge of contraceptive methods increased, and women reported a desire to have fewer children.4 As a result, the program was integrated into the national health policy in Ghana in 1999 and – with the support of substantial implementation research - the program was gradually scaled nationally. Implementation research found that community engagement was integral to the success and longevity of the program. Community input has been integrated throughout planning of the program; one component of the implementation guide is “15 Steps and Milestones for CHPS Implementation” which identifies multiple opportunities for community leaders and end-users to provide feedback and sign off on implementation activities.5 

Outcomes & Impact:

Scale-up has been slower than planned due to financial and logistical constraints on CHO recruitment, training, and deployment as well as challenges with information systems, resources, planning, and effective leadership.3 While 85% of districts had initiated planning and training in 2003 – four years after scale-up -  few had progressed and initiated service delivery.1 Despite this, the Upper East Region, the poorest in Ghana, has experienced remarkable scale up since 1999 with health coverage five times the national average, and CHPS is now present in all of the districts in Ghana.3 6 The Ghana Health Service is still working to improve CHPS coverage and achieve Universal Health Coverage. The CHPS model has inspired reforms throughout Africa including in Ethiopia, Burkina Faso, Tanzania, Nigeria, and Sierra Leone.7 The 2016 annual report form the Ghana Health Service found that Ghana has nearly 95% immunization coverage and a neonatal mortality rate of 6.28 per 1000 live births.

Suggested citation: “Population Health Management: Ghana.” Improvement Strategies. Primary Health Care Performance Initiative, 2018, https://improvingphc.org/ghana. Accessed [insert date].

 

References:

  1. Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller R a. The Ghana Community-based Health Planning and Services Initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20(1):25–34.
  2. World Bank. Ghana Country Profile. 2017.
  3. Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Wang C, Schmitt ML. Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana. Glob Heal Sci Pract. 2013 Mar;1(1):117–33.
  4. Debpuur C, Phillips JF, Jackson EF, Nazzar A, Ngom P, Binka FN. The Impact of the Navrongo Project on Contracepitve Knowledge and USe, Reproductive Preferences, and Fertility. Stud Fam Plann. 2002;33(2):141–64.
  5. Summary of 15 steps and milestones for CHPS implementation. Available from: http://improvingphc.org/sites/default/files/15%20steps%20and%20milestones%20for%20CHPS%20implementation_1.pdf
  6. Awoonor-Williams JK, Phillips JF, Bawah AA. Catalysing the Scale-Up of Community-Based Primary Health Care in a Rural Impoverished Region of Northern Ghana. Int J Health Plann Manage. 2015;(July 2015):273–89.
  7. Koku Awoonor-Williams J, Tadiri E, Ratcliffe H. Translating research into practice to ensure community engagement for successful primary health care service delivery: The case of CHPS in Ghana [Internet]. Primary Health Care Performance Initiative. [cited 2017 Aug 9]. Available from: https://improvingphc.org/translating-research-practice-ensure-community-engagement-successful-primary-health-care-service-delivery-case-chps-ghana-0
  8. Ghana Health Service: 2016 Annual Report. 2016.