A new report, released to mark the first International Universal Health Coverage (UHC) Day, has shown how countries like Ghana can accelerate progress towards health for all, using data to spur innovations in primary health care.
The report comes from the Primary Health Care Performance Initiative (PHCPI) and features case studies that show how Ghana as well as Argentina, Rwanda, Senegal, and Tanzania has made groundbreaking strides with better data collection, analysis, dissemination and use.
The countries featured in the report were selected because of their commitment to using data to improve PHC service delivery and their work with PHCPI to apply a series of measurement tools to reach their goals.
These innovations have strengthened primary health care and resulted in significant improvements for their citizens' health and wellbeing.
Titled, Measuring What Matters: Case Studies on Data Innovations for Strengthening Primary Health Care, the report demonstrates a broad range of ways that data can be used to improve PHC. It said the characteristics of high- performing PHC can be supported and improved through better data collection, analysis, dissemination, and use. They also show that generating evidence and using information strategically are crucial to realising the promise of PHC.
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The report details how Ghana used evidence to scale up community-based health care around the country through its Community-based Health Planning and Services (CHPS, which is now considered one of the most successful health development experiments conducted in Africa.
CHPS was launched in 2000 to scale up proven community-based PHC strategies, with the ultimate goal of achieving UHC. What began as a pilot project in three communities within a single district now reaches more than 4,576 communities across all of Ghana's 216 districts.
According to the report, the remarkable success of CHPS in Ghana is a result of evidence-based planning throughout the past two decades. By conducting a pilot project and using evidence to inform the scale-up of successful practices, Ghana has been able to improve the quality of health care nationwide.
CHPS grew out of a pilot project which began in 1994 in the Upper East Region during which rapid declines in child mortality was documented when nurses were deployed to highly engaged communities. These results were validated in a 1998 replication trial in the Nkwanta District of the Volta Region.
The key strategy used by CHPS—which was based on findings that poor populations were not being reached by traditional health programmes—is to assign nurses, known as community health officers (CHO), to villages. There, they serve as people's first point of contact with the health system and are supported by community volunteers.
The community often builds a CHPS compound where the CHO and outreach services are based. A community health management committee, comprising representatives from the local community, oversees both the management of the compound and the team of community health volunteers.
The Navrongo model was adopted as national policy in 1999, and the Ministry of Health and the Ghana Health Service (GHS) launched CHPS the following year in all of the districts in Ghana.
The country had aimed to expand CHPS to all communities by 2015, but GHS has since found that this level of service coverage would take five decades based on the rate of progress of the scale-up efforts.
To address these implementation challenges, GHS launched the Ghana Essential Health Intervention Programme (GEHIP) in 2010 to identify reforms that can facilitate expansion of CHPS across the country and generate evidence to build district-level political support for CHPS.
The interventions it tested included expanding the role of CHOs, training nurses and their supervisors in leadership skills, providing supplemental funding for CHPS startup activities, improving district- level management and planning, building political engagement, implementing a community-engaged emergency referral system, and implementing interventions to address key challenges in areas such as budgeting and resource mobilisation.
In early CHPS implementation efforts, the routine health information management system for CHPS was found to be cumbersome and underutilised by CHOs.
GEHIP developed new tools to monitor and evaluate the CHPS scale-up, including tools to integrate with the national District Health Information Management System (DHIMS-2) and enable realtime access to data on implementation and progress.
These solutions allowed CHOs to spend less time on data collection and more time on clinical care and to access information supporting routine service delivery. This simplification of data entry processes, combined with clear guidelines for data entry, improved the quality of administrative data in the routine health management information systems.
CHPS coverage expanded significantly faster in the intervention districts. The quality of services was enhanced due to improved retention of frontline health workers, and referral systems improved, including emergency transport to higher-level facilities.
Contraceptive uptake increased, maternal and newborn survival improved, and under-five mortality declined. Further, the estimated time required for national expansion of CHPS coverage based on these reforms dropped from 50 years to five years.
The next step was to build on the success of GEHIP by replicating the reforms from the Upper East Region in other parts of the country.
The National Programme for Strengthening the Implementation of the Community-Based Health Planning and Services Initiative in Ghana, or CHPS+, was launched in 2016 as a five-year project to test the replication of GEHIP strategies in the Northern and Volta regions and produce evidence that these reforms could be used at an even larger scale.
Improving data collection
Under CHPS+, the systems learning districts have improved and simplified data systems and provide training to frontline providers, supervisors, and managers in the use of monitoring tools, evidence generation, and data use to support decision-making.
To measure the impact of CHPS+, Ghana launched a comprehensive evaluation of the study districts, led by the Regional Institute of Population Studies at the University of Ghana, in 2018.
The collection and use of data to support health systems research, experimentation, and evidence generation has been critical to Ghana's success in identifying concrete actions that can be taken to improve the CHPS programme and move closer to achieving UHC.
Through its efforts, Ghana has proven the importance of not only generating evidence, but also ensuring that evidence is disseminated and used for nationwide scale-up of proven interventions.