Over the weekend, I asked several Public Health luminaries some questions on Ghana’s CHPS.
Questions: Good morning, Sir. Last year, I asked several people this question:
The Community-based Health Planning and Services (CHPS) started as the ‘Navrongo Experiment’ in Ghana. I understand other countries adopted it. Please can you give me other countries that adopted it with references. Thank you.
A senior colleague responded that these countries adopted the CHPS: Ethiopia, Sierra Leone, Liberia, Burkina Faso.
I have gone through the literature but I cannot find any document on CHPS in any country apart from Ghana. Please do you have any references on countries other than Ghana that are using the CHPS that you can share with me?
Is the CHPS in Ghana is a unique healthcare system in the world, or we are doing exactly what others are also doing but with a different name? Thank you.
Dr. Koku Awoonor-williams gave a great answer that I would like to share:
Dear Dr. Effah,
Reference your message regarding CHPS, let me provide some responses that may be of essence; I hope so. But sorry if this turns out to be a rather long ‘essay’. The history of Ghana PHC/CHPS is an interesting and unique one that needs to be told. Unfortunately, it does not seem so no matter how hard we had tried.
I agree with you on the uniqueness of CHPS – Community-based Health Planning and Services) that may not be seen and heard same in other counties as CHPS. However, I suggest that you go to Google Scholar and search for authors on CHPS (though I am sure you may have come across some of these papers already e.g. Nyonator or Awoonor-Williams or Phillips. For example, if you search for my name “Awoonor-Williams” as an author and “Tanzania” there are more than 49 articles displayed.
Similarly, there are 38 citations of my authored papers when you search for papers about Nigeria with my name as the author. I personally do not have publications about either country, but citations suggest that for instance my papers have some link with programme action and learning in Tanzania and Nigeria.
One thing I observed is that putting my name as an author and any country with a community-based programme as the search team will see many such citations. Doing this for each country say Ethiopia, Sierra Leone, Libera, Kenya, Tanzania, Mozambique etc will clarify the type of impact of our work on CHPS.
I vividly remembered that at one time myself, Prof Binka and Prof. Phillips agreed that we need to assemble a paper on Ghana’s exchange experience with other countries. But, we never moved forward with this idea.
Now to your substantive question, my immediate response is that, to the best of my knowledge, no other country has a programme named “Community-based Health Planning and Services” (CHPS).
This name was adopted in preparation of a 1999 National Health Forum which was then convened by the Ministry of Health under the direction of Dr. Moses Adibo, then Director of Medical Services, as it was then called, who is an astute health planner, a great thinker and health leader, and there on CHPS has been used in policy documents in Ghana ever since as the main PHC strategy and pathway for delivery basic community based services.
Many countries have community-based primary health care initiatives, and there is much variation for example in the staffing, type of services, and worker deployment schemes that are used.
What is disseminated by Ghana, of which I was part and can say at the centre, however is the notion that implementation research should be used to guide the strategies that are employed for PHC. Also, we have advocated phasing research in a way that builds programme effort around a process of evidence-driven learning.
To promote this idea, myself and other colleagues, including Dr Nyonator (May he rest in peace), Prof. Akosa DG then, Prof. James Philips participated in the founding of the WHO ExpandNet initiative, (you can google) which has subsequently evolved into an international NGO (www.expandnet.net) and we sponsored several exchanges that provided implementers of community-based primary health care with direct experience with our CHPS approach.
Over the 2004 – 2005 period, there were separate exchanges involving implementation teams from Sierra Leone, Burkina Faso, Kenya and Ethiopia to mention those I can readily remember. A series of exchanges were conducted for implementation teams from four northern Nigeria states in 2009-2010 which I facilitated in the UER. The role of the Navrongo Research Centre (and Prof. Binka’s effort) in all these exchanges and work is transformational in our PHC agenda and subsequent roadmap.
The pioneering role of Nkwanta for instance as a centre for validating the original study and later an important field site for team exchanges and orientation was crucial both in national dissemination discourse and learning across our borders.
Of course a few districts came on board later, AAK district in Central Region, Birim North in Eastern Region, Juabeso Bia in Western region and Sene in the Ashanti region to mention a few.
Of all these exchanges, the Ethiopia Health Extension Programme (HEP) which I am sure you are familiar with, is probably the best known. The current WHO DG Dr. Tedros was part of that exchange at the time, as Minister of Health of Ethiopia, and displayed keen interest and commitment to PHC.
Indeed even then I could see right then that is a staunch believer in reaching majority of population with basic PHC services particularly promotivce and preventive as CHPS had shown. I hosted them for a full 4 days at Nkwanta with extensive community field visits and learning.
Quite independent of any input from us, Ethiopia had decided to launch HEP prior to their visit to Ghana. But I believe that our exchange conveyed the message that learning from research could contribute the quality and effectiveness of their programme.
Later, in 2010, a team from Tanzania visited Ghana and designed a field experiment based on lessons learned. This project, known as CONNECT (you can google) also published several papers and had an impact on a national programme for improving primary health care in that country.
I do not believe that any country has replicated all elements of Ghana’s CHPS. In fact, I do not also advocate for outright operational replication.
Instead, what we all did at the time and continue to do was to advocate a process of learning, exchange, and dissemination that can impact on strategic thinking about designing systems for community-based primary health care. In my honest view, if a country team uses the CHPS process in some other setting, what will emerge will be adapted to the local context and responsive to local needs.
A CHPS process employed elsewhere will thereby produce a very different system of care than the programme that we have developed for Ghana and been implementing all these years.
I have more to share on context itself and CHPS as implemented now in Ghana, but that probably will be for another time. I hope this rather long response will be useful to the question. I just tried to provide a little background to the CHPS story and hopefully we can continue this discussion.
Best, Koku