Pragmatic Observations and Policy Outcomes Associated With the Nkwanta Replication Process, Ghana
| Program Component | Observation of Pilot Investigators | National Policy Outcomes |
|---|---|---|
| Staffing | ||
| Nurse and volunteer deployment and management | Replication of the Navrongo model was feasible and affordable, although cultural heterogeneity required greater focus on community engagement and community-based decentralization than in Navrongo. | A 1999 National Health Forum adopted CHPS as national policy.9 The combined configuration of worker deployment was replicated. Implementation results legitimized national implementation policy commitment.79,80 |
| Capacity building | ||
| Training | Within district, implementation required implementation-based team demonstration to supplement technical training.80 | Results led to established systems of CHPS-specific operational guidelines and orientation for CHNs before and during deployment. |
| Within-district scale-up | Peer learning was essential to community-based replication of CHPS operations. Team exchanges developed systems thinking at each level of the operation.80 | Intra-district teams peer exchanges and CHPS operations orientation among facilities was instituted. |
| Between district dissemination of operational learning | Although six essential milestones were critical to disseminating CHPS,79,81,82 their replication required participatory learning. Didactic training and documentation of approaches were helpful but insufficient. 82 Eight lead districts were trained in peer learning processes.83 | District teams’ peer exchanges and CHPS operations’ orientation among districts with CHPS centers of excellence was instituted in other districts (e.g., Birim North, Abura-Asebu-Kwanakese, and Juabeso Bia districts). |
| Support systems learning | ||
| Supervision and management | Supervision was focused on visiting their assigned communities for collaborative problem solving.84 | Regular subdistrict health teams and DHMT quarterly supportive supervision were established. |
| Logistics and supply | Through the support of another project, the Ghana Essential Medicines Initiative, critical supplies and medicines were made available at CHPS locations that meet the needs of the disease’s profiles of the zones. | Basic essential supplies and equipment list was developed for CHPS operations and donor support for logistics was marshaled. |
| Research and knowledge management | ||
| Within district learning processes | Durbars that involved participatory leadership exchanges could be used to spread community-level understanding of CHPS and commitment to scale up. | Developed manuals and guidelines for community engagement and understanding of CHPS and community durbars regularized. |
| Scaling up learning | Experiential learning through participation and observation was an effective means of building senior official knowledge of implementation processes and results. | Annual national health fora and senior managers conferences became focal points for CHPS operations and discussion and performance evaluation. |
Abbreviations: CHN, community health nurse; CHPS, Community-based Health Planning and Services; CHV, community health volunteers; DHMT, district health management team.