RT Journal Article
SR Electronic
T1 Using Health Systems and Policy Research to Achieve Universal Health Coverage in Ghana
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2100763
DO 10.9745/GHSP-D-21-00763
VO 10
IS Supplement 1
A1 Awoonor-Williams, John Koku
A1 Apanga, Stephen
A1 Bawah, Ayaga A.
A1 Phillips, James F.
A1 Kachur, Patrick S.
YR 2022
UL http://www.ghspjournal.org/content/10/Supplement_1/e2100763.abstract
AB Key FindingsCoordinated cycles of implementation research, planning, and testing innovations and policy reforms have contributed incrementally to the Community-based Health Planning and Services (CHPS) initiative achieving national scale and improving geographic access to primary health care services at the community level.Achieving and maintaining high levels of financial access through the National Health Insurance Scheme (NHIS) has been more elusive, although research and evaluation evidence has also been utilized to support implementation reforms and refinements.Although the NHIS contributed to increased use of CHPS services among the poorest, this increase is skewed toward curative care treatment, rather than comprehensive primary health services that include promotive and preventive care.Key ImplicationsAchieving universal health coverage (UHC) in Ghana requires integrating the CHPS initiative and NHIS operations into a fully functional system of care.A comprehensive system-learning approach should be adopted in addressing service readiness, geographic availability, and financial access all together.Additional research such as a plausibility trial of systems solutions is needed to fully integrate NHIS reform with Ghana’s Roadmap for Attaining Universal Health Coverage, 2020–2030.Ghana is positioned to become the first country in sub-Saharan Africa to implement universal health coverage based on nationwide expansion of geographic access through the Community-based Health Planning and Services initiative. This achievement is the outcome of 3 decades of implementation research that health authorities have used for guiding the development of its primary health care program. This implementation research process has comprised Ghana’s official endorsement of the 1978 Alma Ata Declaration, leading to the institutionalization of evidence relevant to the strategic design of primary health care and national health insurance policies and services. Rather than relying solely upon the dissemination of project results, Ghana has embraced a continuous and systemic process of knowledge capture, curation, and utilization of evidence in expanding geographic access by a massive expansion in the number of community health service points that has taken decades. A multisectoral approach has been pursued that has involved the creation of systematic partnerships that included all levels of the political system, local development officials, community groups and social networks, multiple university-based disciplines, external development partners, and donors. However, efforts to achieve high levels of financial access through the roll-out of the National Health Insurance Scheme have proceeded at a less consistent pace and been fraught with many challenges. As a result, financial access has been less comprehensive than geographical access despite sequential reforms having been made to both programs. The legacy of activities and current research on primary health care and national health insurance are reviewed together with unaddressed priorities that merit attention in the future. Factors that have facilitated or impeded progress with research utilization are reviewed and implications for health systems strengthening in Ghana and elsewhere in Africa and globally are discussed.