Utilizing Successful Research in Community-Based Services with Constrained Resources: The Nkwanta Experience Catalyzing Organizational Change in Rural Ghana

John K Awoonor-Williams, Volta Regional Health Administration
Tanya C. Jones, Population Council
Frank Nyonator, Ghana Health Service
James F. Phillips, Population Council

There are few examples in the developing world where health care reform and innovation is founded on evidence-based research. This paper presents the experience of Nkwanta District, located in the Volta Region of southeastern Ghana, which has successfully replicated service delivery innovations developed by the Navrongo Health Research Centre in northern Ghana. Using locally available and highly constrained resources, the Nkwanta initiative has demonstrated that the success of Navrongo operations is not a mere artefact of the special resources of a research initiative, but are potentially relevant to rural impoverished districts throughout Ghana. The Nkwanta approach to utilizing Navrongo operations is being used to guide a national programme of decentralised planning and administration for improving health coverage and developing a broad range of village-based primary health care services. Known as Community-based Health and Planning Services (CHPS), this program of health service change and development now operates in 95 of Ghana’s 110 districts. This paper describes the process of CHPS implementation in Nkwanta, lessons regarding the adaptation of an experimental program to another resource constrained setting, and implications of the replication of Navrongo services in Nkwanta for the national health service development program. A national CHPS MIS system has been developed to monitor CHPS implementation. Results show that districts of Ghana where change has been early, sustained, and rapid represent districts where implementation teams have visited Navrongo or Nkwanta, developed plans for a small scale pilot, and phased in the process of change using local plans and resources. Evidence suggests that counter-part training approaches leading to participatory planning capabilities, represent a more effective basis for fostering operational change than approaches that rely upon technical training, central directives, or national policy guidelines. The accomplishments of Nkwanta district provide necessary momentum to, and validation of the CHPS paradigm --the only national health development program in sub-Saharan Africa that is based on findings from experimental research.