Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Global Policy and Advocacy Network (GLOOPLAN), Accra, Ghana.
BMJ Open. 2019 Feb 22;9(2):e024845. doi: 10.1136/bmjopen-2018-024845.
Community-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and middle-income countries. This study is first of its kind (following the launch of the Sustainable Developments Goal [SDG]) and aimed to holistically explore the challenges to achieving UHC through the community-based health planning and service (CHPS) initiative in Ghana.
A qualitative study design was adopted to explore the phenomenon. Face-to-face indepth interviews were conducted from April 2017 until February 2018 through purposive and snowball sampling techniques. Data were analysed using inductive and deductive thematic analysis approach.
Data were gathered at the national level, in addition to the regional, district and subdistrict/local levels of four regions of Ghana. Sampled regions were Central Region, Greater Accra Region, Upper East Region and Volta Region.
In total, 67 participants were interviewed: national level (5), regional levels (11), district levels (9) and local levels (42). Interviewees were mainly stakeholders-people whose actions or inactions actively or passively influence the decision-making, management and implementation of CHPS, including policy makers, managers of CHPS compound and health centres, politicians, academics, health professionals, technocrats, and community health management committee members.
Based on our findings, inadequate understanding of CHPS concept, major contextual changes with stalled policy change to meet growing health demands, and changes in political landscape and leadership with changed priorities threaten CHPS sustainability.
UHC is a political choice which can only be achieved through sustainable and coherent efforts. Along countries' pathways to reach UHC, coordinated involvement of all stakeholders, from community members to international partners, is essential. To achieve UHC within the time frame of SDGs, Ghana has no choice but to improve its national health governance to strengthen the capacity of existing CHPS.
以社区为基础的举措具有巨大的潜力，可以促进全民健康覆盖（UHC）和卫生系统的发展。然而，在许多低收入和中等收入国家，仍存在一些关键差距，这对其可持续性构成威胁。本研究是此类研究中的首例（可持续发展目标发布后），旨在全面探讨加纳基于社区的卫生规划和服务（CHPS）举措在实现全民健康覆盖方面所面临的挑战。
本研究采用定性研究设计来探索这一现象。通过目的性和滚雪球抽样技术，于 2017 年 4 月至 2018 年 2 月期间进行了面对面深入访谈。采用归纳和演绎主题分析方法对数据进行分析。
除加纳四个地区（中部地区、大阿克拉地区、上东部地区和沃尔特地区）的地区、区和分区/地方级别外，还在国家一级收集数据。
共有 67 名参与者接受了访谈：国家一级（5 名）、地区一级（11 名）、区一级（9 名）和地方一级（42 名）。受访者主要是利益攸关方，他们的行动或不作为积极或消极地影响 CHPS 的决策、管理和实施，包括政策制定者、CHPS 综合卫生中心经理、政治家、学者、卫生专业人员、技术专家以及社区卫生管理委员会成员。
根据我们的研究结果，对 CHPS 概念的理解不足、主要背景变化导致政策停滞以满足不断增长的健康需求，以及政治格局和领导层的变化导致优先事项发生变化，这些都对 CHPS 的可持续性构成威胁。
全民健康覆盖是一项政治选择，只能通过可持续和连贯的努力来实现。在各国实现全民健康覆盖的道路上，从社区成员到国际合作伙伴，所有利益攸关方的协调参与至关重要。为了在可持续发展目标的时间框架内实现全民健康覆盖，加纳别无选择，只能加强现有的 CHPS，改善国家卫生治理。
