Abstract:
Background
Jhpiego implemented a 5-year project to strengthen the Community-Based Health Planning
and Services (CHPS) model in six coastal districts of Ghana’s Western Region. The project
utilized a quality improvement approach (Standards-Based Management and Recognition
[SBM-R]) to strengthen implementation fidelity of the CHPS model. This article presents
findings from an end-of-project evaluation comparing quality, access to care, and experi-
ence of care in intervention and comparison CHPS zones.
Methods
A non-equivalent, posttest–only, end-of-project evaluation compared 12 randomly selected
intervention zones with 12 matched comparison zones. Data from standards-based assess-
ments measured provision of care in three categories: community engagement, clinical ser-
vices, and facility readiness and management. Access to and experience of care were
assessed using a household survey of 426 randomly selected community members from
the selected CHPS zones. Bivariate and multivariate analyses were conducted to compare
performance on these measures between intervention and comparison CHPS zones.
Results
Overall, intervention zones outperformed comparison zones on achievement of standards
(83.6% vs 58.8%) across all three assessment categories, with strongest results in commu-
nity engagement (85.7% vs. 41.4%). Respondents in intervention zones were more than
twice as likely to have received a home visit from a community health officer, three times as
likely to have a home visit from a community health volunteer, and more likely to have attended a health talk (41.9% vs. 27.0%). Client experiences of care were reported as posi-
tive in both study arms.
Conclusions
The evaluation demonstrated improved access to quality care; however, there were very
few differences in client experience of care between intervention and comparison zones. As
Ghana and other countries are committed to scaling up universal health care, a pragmatic
approach such as SBM-R could prove useful to engage both facility- and community-based
service providers, as well as community members, to improve provision of care.
