Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana: a methodological approach

Abstract

BackgroundNearly four decades after the Alma-Ata declaration of 1978 on the need for active client/community participation in healthcare, not much has been achieved in this regard particularly in resource constrained countries like Ghana, where over 70 % of communities in rural areas access basic healthcare from primary health facilities. Systematic Community Engagement (SCE) in healthcare quality assessment remains a grey area in many health systems in Africa, albeit the increasing importance in promoting universal access to quality basic healthcare services.Purpose/objectiveDesign and implement SCE interventions that involve existing community groups engaged in healthcare quality assessment in 32 intervention primary health facilities.MethodsThe SCE interventions form part of a four year randomized controlled trial (RCT) in the Greater Accra and Western regions of Ghana. Community groups (n = 52) were purposively recruited and engaged to assess non-technical components of healthcare quality, recommend quality improvement plans and reward best performing facilities. The interventions comprised of five cyclical implementation steps executed for nearly a year. Wilcoxon sign rank test was used to ascertain differences in group perceptions of service quality during the first and second assessments, and ordered logistic regression analysis performed to determine factors associated with groups’ perception of healthcare quality.ResultsHealthcare quality was perceived to be lowest in non-technical areas such as: information provision to clients, directional signs in clinics, drug availability, fairness in queuing, waiting times, and information provision on use of suggestion boxes and feedback on clients’ complaints. Overall, services in private health facilities were perceived to be better than public facilities (p < 0.05). Community groups dominated by artisans and elderly members (60+ years) had better perspectives on healthcare quality than youthful groups (Coef. =1.78; 95 % CI = [−0.16 3.72]) and other categories of community groups (Coef. = 0.98; 95 % CI = [−0.10 2.06]).ConclusionsNon-technical components of healthcare quality remain critical to clients and communities served by primary healthcare providers. The SCE concept is a potential innovative and complementary quality improvement strategy that could help enhance client experiences, trust and confidence in healthcare providers. SCE interventions are more cost effective, community-focused and could easily be scaled-up and sustained by local health authorities.

Impact of a bottom-up community engagement intervention on maternal and child health services utilization in Ghana: a cluster randomised trial

“…This was a cluster randomised trial in 64 primary health facilities (32 intervention and 32 control) and their catchment area, as detailed in previous related publications by the lead author [5–8]. Primary health facilities in this context are clinics and health centres as per the Ghana Health Service (GHS) categorizations and pyramidal levels of healthcare.…”

“…This study setting and population are the same as previous publications by the lead author using the same research design and approach (see Alhassan et al [5–8]). The study was thus conducted in the Greater Accra and Western regions of Ghana in 16 administrative districts.…”

“…Randomisation and sampling procedure for this study are same as previous publications by the lead author [5–8] where the sample frame entailed list of primary health facilities credentialed by the NHIA. Primary health facilities were purposively selected for this study because they are relatively less complex in terms of health service delivery and could easily be monitored for impact of the implemented intervention [7].…”

“…Empirical studies have advocated community-based health interventions as a leverage to improving access to maternal and child. Community-based health interventions have proved to be effective towards promoting acceptability and utilization of health services [5–8].…”

Can a standards-based approach improve access to and quality of primary health care? Findings from an end-of-project evaluation in Ghana

“…An approach used by Alhassan et al [42] found that facilitating systematic community engagement (SCE) interventions around quality of care enabled existing community groups to reflect on perceived quality of care, using 10 pre-defined domains detailed on a community scorecard. Community feedback was shared with health providers who used the information to develop action plans to address gaps in perception of quality.…”