Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: The case of Ghana’s Community-based Health Planning and Services (CHPS)

  • Health Research Policy and Systems, Volume 12, No. 1, Year 2014

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Study Justification:
The study aimed to address the health challenges faced by the urban poor in Ghana’s informal settlements. It sought to determine if the proven innovations used in the rural Community-Based Health Planning and Services (CHPS) system could be adapted to fit the urban setting. The study was part of a broader experiment testing health innovations in Ghana and Tanzania.
Highlights:
1. The study focused on the implementation of an urban primary health system based on the rural CHPS model.
2. It identified the unique organizational structures and epidemiological characteristics of urban communities that required modifications to the rural milestones.
3. The study found that certain practices, such as constructing Community Health Compounds, were not suitable for urban areas.
4. Night and weekend home visit schedules were initiated to accommodate urban residents and increase coverage.
5. The breadth of the disease burden in urban areas required broader expertise and training of Community Health Officers (CHOs).
Recommendations:
1. Current policy guidelines for implementing primary health models based on rural experiences need to be reviewed and modified to meet the needs of urban settings.
2. Strategies for improving access to urban health services should be developed, considering the unique challenges faced by the urban poor.
3. Training programs for CHOs should be expanded to include a broader range of expertise to address the diverse health needs in urban areas.
Key Role Players:
1. Government health agencies and policymakers.
2. Community leaders and representatives.
3. Health professionals and practitioners.
4. Non-governmental organizations (NGOs) working in health and development.
5. Researchers and academics.
Cost Items for Planning Recommendations:
1. Training programs for CHOs to enhance their skills and expertise.
2. Development and implementation of strategies to improve access to urban health services.
3. Research and evaluation activities to monitor the progress and impact of the modified CHPS model.
4. Collaboration and coordination efforts among key stakeholders.
5. Public awareness campaigns to promote the importance of urban health services.
Please note that the cost items provided are general categories and not actual cost estimates. The specific budget items would depend on the context and priorities of the implementing organization or government.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides an overview of innovative experiences in adapting the rural Community-Based Health Planning and Services (CHPS) model to address urban health challenges in Ghana. The research was conducted during a six-month pilot of the urban CHPS program, and routine data were collected to compare the intervention and control communities. The findings highlight the need for modifications to the rural CHPS model to meet the unique organizational structures and epidemiological characteristics of urban settings. The study also mentions the use of qualitative appraisal and simulations to inform the adoption of new strategies. To improve the strength of the evidence, the abstract could include more specific details about the data collection methods, sample size, and statistical analysis. Additionally, providing information on the limitations of the study and potential biases would further enhance the evidence.

Background: Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana.Methods: This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones.Results: The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs.Conclusions: Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings. © 2014 Adongo et al.; licensee BioMed Central Ltd.

This study forms part of a broader quasi-experiment designed to test proven health innovations in Ghana (Ghana Essential Health Intervention programme, GEHIP) and Tanzania (Tanzania Essential Health Intervention Programme, TEHIP) on maternal and child health [23]. The study was carried out in the Ga East municipality of the Greater Accra region, which has a large concentration of informal settlements serving as a residence for many rural to urban migrants. The municipal capital is at Abokobi and covers a total land size of about 166 km2. The municipality is divided into four zones with 16 operational areas consisting of 42 communities. The 2010 Ghana’s Population and Housing Census indicated that the total population of the municipality was 259,668, with 127,258 and 132,025 representing the male and female populations, respectively [21]. The municipality is divided into four sub-municipalities for the organization of primary health care services, namely Madina, Danfa, Taifa, and Dome. Ethical approval for this study was received from the Ethics and Institutional Review Committee of the GHS and the Navrongo Health Research Centre in the Upper East region of Ghana. The Greater Accra regional branch of the GHS was subsequently informed of the intervention and institution approval received from the GHS. A baseline study was first carried out to provide data that could be used to monitor the progress of the intervention. Written informed consent was sought from all respondents which were mainly women in their reproductive ages (15 to 49 years old). Participants were further informed of their right to withdraw from the study at any time without any punitive measure taken against them. Personal identifiers were not taken and, if accidentally taken, they were removed from the data before analysis. Following the baseline survey, the pilot phase of the urban CHPS was then launched in the intervention sub-district (Dome). The urban CHPS initiative is designed to test whether the approaches of ‘bringing services to the people’, and strengthening communities to ‘bring health to themselves’, can overcome barriers to reproductive health and improve child survival in urban and peri-urban slum areas, thereby promoting health equity within urban neighbourhoods. It aims to improve access to quality health care, expand the referrals of cases/case referrals, and to increase the health knowledge of the community. After a series of consultations and meetings with key stakeholders, including members of the community, political authority and the health sector, a formative qualitative appraisal was conducted to determine the form and nature in which urban CHPS could be implemented. The qualitative formative research provided information on the social composition of the urban population, health-seeking behaviours for infant, child, and maternal health, health decision making at the local level, social factors influencing healthcare provision, the community conceptualization of Urban CHPS, and potential models for the programme’s design. Upon the completion of the qualitative appraisal, two models of urban CHPS, one using the rural milestones and a modified version were developed and tested in the Dome sub-district of the Ga East District. Two zones, Ayigbe and Grushie, were created in separate communities for the pre-testing. The rural milestones were tested at Ayigbe town whilst modifications to the rural milestones were tested at Grushi town. The pilot study was conducted from September to December 2011 focusing purely on maternal and child health-related interventions. Several lessons were learnt from the two models, which led to some modifications and subsequent scale up. The routine data collected were reviewed monthly and analysed to inform the adoption of the new strategies. The coverage and other daily reports from the CHOs was compared. Simulations were employed to test which strategies would be appropriate for the urban settings. A number of strategies were adopted and tested until a particular strategy emerged as an appropriate one in the intervention communities. Additionally, another qualitative appraisal was carried out to elicit information from stakeholders on the most appropriate strategy for the urban setting. The operational differences between the rural CHPS and the urban CHPS were then documented and have been presented in the results in the form of narratives.

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Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Night and weekend home visit schedules: To better accommodate urban residents and increase coverage, implementing night and weekend home visit schedules can ensure that pregnant women and new mothers receive the necessary care and support outside of regular clinic hours.

2. Broadening expertise and training of Community Health Officers (CHOs): Given the breadth of the disease burden in urban areas, it is important to provide CHOs with broader expertise and training to address the specific health needs of urban residents. This can include additional training on urban health challenges and specialized skills to handle a wider range of health conditions.

3. Modifying the design of Community Health Compounds: While constructing Community Health Compounds and residential facilities within zones may be appropriate for rural areas, it may not be suitable for urban settings. Modifying the design of these compounds to better fit the urban context can help ensure that maternal health services are accessible and convenient for urban residents.

4. Formative qualitative research: Conducting formative qualitative research to understand the social composition of the urban population, health-seeking behaviors, and community conceptualization of urban health services can help inform the design and implementation of maternal health interventions. This research can provide valuable insights into the specific needs and preferences of urban communities.

5. Testing and adapting different models: Through pilot studies and simulations, testing and adapting different models of urban CHPS can help identify the most effective strategies for improving access to maternal health services. This iterative process allows for continuous learning and refinement of interventions based on real-world implementation and feedback from stakeholders.

It is important to note that these recommendations are based on the specific context and findings of the study mentioned. When implementing innovations to improve access to maternal health, it is crucial to consider the unique characteristics and challenges of the target population and adapt interventions accordingly.
AI Innovations Description
The study mentioned in the description focuses on improving access to maternal health in urban areas, specifically in Ghana. The researchers aimed to adapt the successful rural Community-Based Health Planning and Services (CHPS) model to address the unique challenges faced by urban communities.

The study found that certain practices from the rural CHPS model could not be directly applied to urban settings due to differences in organizational structures and epidemiological characteristics. For example, constructing Community Health Compounds and residential facilities within zones, which worked well in rural areas, proved to be inappropriate for urban areas. Instead, night and weekend home visit schedules were initiated to accommodate urban residents and increase coverage.

The study also highlighted the need for broader expertise and training of Community Health Officers (CHOs) to address the diverse disease burden in urban communities.

Based on the findings, the researchers recommended that current policy guidelines for implementing primary health models based on rural experiences be carefully reviewed and modified to meet the specific needs of urban settings. This would involve adapting and testing different strategies until an appropriate approach is identified for urban communities.

Overall, the study emphasizes the importance of developing innovative approaches to improve access to maternal health in urban areas, taking into account the unique challenges and characteristics of these settings.
AI Innovations Methodology
The study mentioned in the description focuses on the design and implementation of proven innovations for delivering basic primary health care services in rural communities and examines whether these innovations can be adapted to fit the urban setting in Ghana. The specific innovation being tested is the Community-Based Health Planning and Services (CHPS) model.

To improve access to maternal health in urban areas, the study explores various adaptations to the CHPS model. Some of the modifications made include initiating night and weekend home visit schedules to accommodate urban residents, constructing Community Health Compounds and residential facilities within zones, and providing broader expertise and training to Community Health Officers (CHOs) to address the diverse disease burden in urban areas.

To simulate the impact of these recommendations on improving access to maternal health, the study employs a methodology that involves several steps. First, a baseline study is conducted to gather data on the current state of maternal health in the intervention area. Written informed consent is obtained from participants, and personal identifiers are removed from the data to ensure privacy.

Next, the pilot phase of the urban CHPS is launched in the intervention sub-district. This phase aims to test the effectiveness of the adapted CHPS model in improving access to quality health care, expanding case referrals, and increasing health knowledge in the community. Two models of urban CHPS, one using the rural milestones and a modified version, are developed and tested in separate communities.

Routine data collected during the pilot phase are reviewed and analyzed monthly to assess the impact of the different strategies. Simulations are employed to test which strategies are most appropriate for the urban setting. Additionally, qualitative appraisals are conducted to gather feedback from stakeholders on the effectiveness of the strategies and to determine the most appropriate approach for the urban setting.

The operational differences between the rural CHPS and the urban CHPS are documented and presented in the results of the study. This information can then be used to inform policy guidelines and modifications to the CHPS model to better meet the needs of urban settings and improve access to maternal health services.

Overall, the methodology used in this study involves data collection, pilot testing, analysis, simulations, and stakeholder feedback to assess the impact of adapted CHPS strategies on improving access to maternal health in urban areas.

Statistics:
Citations: 24
Authors: 8
Identifiers:
DOI: 10.1186/1478-4505-12-16
Research Areas:
Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Technology and Innovations
Study Countries:
Ghana, Multi-Countries, Tanzania
Study Design:
Cross Sectional Study, Exploratory Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Male & Female
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