Five steps Ghana took to infuse evidence into its primary health care system
Ghana has a long track record of using research to improve the way health services are delivered across the country. The Navrongo experiment, some thirty years ago, helped to set a path for primary health care services in the country, and it is the origin of the current Community-based Health Planning and Services (CHPS) programme. However, scale up from one experiment to a national programme proved a challenge. Embedding research in the roll out process and tailoring the programme to different areas has underpinned its success.
How did Ghana create an environment for embedded research? And in the context of the current COVID-19 crisis, how can health systems build on local research and data to respond to the big challenges of today?
The Alliance recently published a detailed story of change on Ghana’s journey to embedding research into policy- and decision-making. Below, we highlight the five steps that were critical for Ghana in establishing a culture of learning, responsiveness and evidence use.
Step 1: Believe in research
Trust in the power of research evidence. Ghana has worked over the last thirty years to build a ‘learning health system’: research and routine data collected through health services play a large role in decision-making and identifying challenges. The creation of three health research centres spread across the country has become a critical part of its health service. A lot of effort has also gone into establishing strong links with researchers working in local universities. This has all contributed to a culture shift that has allowed for greater use of evidence in decision-making about the way services are delivered.
Step 2: Get everyone around the table
Build a shared agenda for change. Successful embedded research projects bring everyone together - researchers, implementers and policy-makers - from the very beginning. In Ghana, the roll out of the CHPS programme also involved directly engaging communities. Input from development partners was also helpful. Agreeing on the questions to be asked, the methods to be used and who is to be involved was critical for moving forward together.
Step 3: Communicate regularly
Share data and intelligence as it becomes available. It has been important in Ghana to share information about what is being revealed while the research is underway. This active sharing has allowed for adjustments to programmes based on new knowledge and for researchers to respond to emerging policy or implementation priorities. For example, in one of the CHPS study areas, some asides made during focus group discussions highlighted that lower-level staff in the health facilities felt that their supervision was too stern and not supportive. The district director was able to swiftly address the issue, holding human resource management training on addressing conflict and conducting monitoring visits. Observing and reacting to new information can have real impacts for those working on the frontline of health.
Step 4: Think local
Research should respond to real-world challenges. Embedded research needs to respond to the problems and challenges that are being faced by policy-makers and health staff on the frontlines. In Ghana, one way they ensured this was through establishing partnerships with local research institutions and not just relying on national or international experts.
Step 5: Keep going
Always build on success. In Ghana, they built on findings from an experiment to create a primary health care system that is addressing the needs of its rural communities. But the scale-up process was not easy and required continued research to support innovations and get the programme back on the right road. Even where the programme is working well, embedded research is helping it to evolve and to respond to changing needs within communities.
Embedding research into policy-making processes and creating a culture of learning within health systems is not something that happened overnight. It has taken decades of effort in Ghana to get to where they are today. But it has been hugely beneficial. Dr Anthony Nsiah-Asare, Director General of the Ghana Health Service between 2017 and 2019 is unequivocal: “if any country wants to improve on their health systems, to strengthen the way that they are working… embedded research is how they should go.”
