Evaluating the Implementation Process of the Networks of Practice Programme in Ghana: An Implementation Research Project (NoP).
January 10, 2025 | Ongoing Project | Reading time: 8 min
Introduction and Background
This Network of Practice (NoP) programme is one of Ghana’s flagship strategies to attain Universal Health Coverage (UHC) with a focus on primary health care. The program, which is led by the Dodowa Health Research Centre, in collaboration with KHRC and Navrongo Health Research Centre, aims at improving quality health services, partnership and innovation. The NoP program connects healthcare facilities within specific areas to form networks that ensure accessible and comprehensive healthcare services. These networks include public, private, and quasi-government health facilities, organized around a central hub (usually a health center.)
These networks are intended to ‘’maximize efficiencies in the use of resources towards improving quality and coverage” by connecting primary care service points around a “hub”. These networks, are organized primarily at the sub-district level, includes public, private, and quasi-government service providers and are nested within a district with strong linkages to district hospitals. The Government of Ghana has identified health centers (HCs), a level of care that falls between first level hospitals and Community-based Health Planning and Services (CHPS) facilities as an important component of networks of practice. In most cases, a HC will be the “hub” of a particular NOP. Currently, this level of care is relatively under-utilized by populations who `tend to bypass it, even for basic services, for higher-level care in hospitals. In a recent study of bypassing in Ghana, 19% of people bypassed primary care facilities for antenatal care, 33% for childbirth and 38% for postnatal care. In sub-districts without any HC, a more developed Community-based Health Planning and Services (CHPS) facility, a polyclinic or a district hospital may be the network’s hub.
Recognizing the relatively new nature of the NOP approach, the Ghana Health Service would like to embed an implementation research (IR) program into the national scale-up, to learn from the scale-up, iterate, adapt, and improve the model as it spreads. IR outcomes of interest are: acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration, and sustainability.
Investigators
Dr John Williams, Prof Kwaku Poku Asante, Dr. Solomon Narh Bana, Dr Martha Abdulai, Miss Theresa Tawiah, Dr. John Amoah, Dr Samuel Chatio.
Objectives
The aim of this implementation research is to evaluate the implementation process of the NoP programme in Ghana for the period 2023–2026 to provide critical data for scale-up and adaptation of the NoP program. Specifically, the study intends:
1.To
explore the agreement and enabling environment of implementing the NoP programme.
2. To evaluate operational standards guiding the implementation of the NoP programme.
3. To evaluate the quality, efficiency and responsibility
of implementing the NoP programme.
4. To identify the learning points and provide feedback for adaptation by the NoP programme.
Methodology
The study is being conducted in some selected districts in all regions of Ghana. Ghana has been divided into 16 administrative regions and these are grouped into three geographical belts, with each led by the 3 research centres; the southern (DHRC), middle (KHRC) and northern (NHRC) belts. The southern belt is made up 6 regions (Western, Western North, Central, Gt. Accra, Volta, and Eastern Regions), the middle belt is made up 5 regions (Ashanti, Bono, Bono East, Ahafo, and, Oti), and finally, the Northern belt (Northern, Savannah, North East, Upper East, and Upper West) is also made up of 5 regions.
Study Design and Sampling
This study is implementation research using a modified stepped wedge sampling technique to evaluate the scale-up of the NoP implementation programme in Ghana. It employs both quantitative and qualitative approaches, curating primary as well as secondary data.
Thirty-four (34) districts in all regions in Ghana will be purposively sampled and assessed by the end of the four-year period of the evaluation. These 34 districts may have an existing network or no network at the time of selection but will be potentially networked by the end of the evaluation period. In each region, two districts are sampled and included in the evaluation. An additional two districts, one piloted NoP each from Bono and Volta regions are purposively sampled and included as part of the networked districts as additional areas of evaluation since Volta and Bono regions have already established many networks.
Data Collection
The evaluation is conducted every 6 months for a period of four years, from 2023 to 2026. The 6-monthly data collection is done in the same districts and facilities, in a longitudinal fashion, resulting in a panel of data for analysis at the end of the evaluation. Data is collected twice yearly over the entire period of the study for an Evidence Translation Firm to use to support the GHS in making decisions on program adaptations.
Expected Outcomes
The expected outcome of this programme includes the acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration, and sustainability of the NOP.
Funders
World Bank
Collaborating institutions
Dodowa Health Research Centre (DHRC) as the lead, Kintampo Health Research Centre (KHRC), Navrongo Health Research Centre (NHRC).
Study Duration : Three (3) Years
Start Date : 2023
End Date : 2026