No abstract

BackgroundThis paper reports on results of a health system strengthening programme implementation research in the Upper East region of northern Ghana where critical interventions to accelerate and strengthen the health delivery were implemented. Transformative interventions implemented included empowering community leaders and actors to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, provision of basic medical equipment to community clinics, and improving the skills of critical health staff training. MethodsA mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. For these analyses a pre-and-post randomized cluster design was used. For the qualitative data focused group and individual indepth interviews were employed to gauge the views of different stakeholders associated with the implementation process. ResultsSignificant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage (ANC and PNC) were observed. Similarly, there were significant increases in delivering of children in a health facilities and deliveries assisted by skilled health personnel after the intervention compared to before intervention situation in the region. There has also been increased uptake of women providing oral rehydration salts (ORS) for treatment of diarrhoea, as well as marked reductions in upper respiratory infections (URI). Conclusions Results from a pre-and post-evaluation impact assessment of interventions implemented in these health deprived parts of Ghana show that the programme had a strong positive impact on the functioning of Ghana’s health delivery system known as Community-based Health Planning and Services programme and induced visible changes in key indicators of health system performance.