Monitoring, Evaluation and Research, Jhpiego, Johns Hopkins University Affiliate, Baltimore, MD, United States of America.
Department of Health Information Management, University of Cape Coast, Cape Coast, Ghana.
PLoS One. 2019 May 10;14(5):e0216589. doi: 10.1371/journal.pone.0216589. eCollection 2019.
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 experience of care in intervention and comparison CHPS zones.
A non-equivalent, posttest-only, end-of-project evaluation compared 12 randomly selected intervention zones with 12 matched comparison zones. Data from standards-based assessments measured provision of care in three categories: community engagement, clinical services, 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.
Overall, intervention zones outperformed comparison zones on achievement of standards (83.6% vs 58.8%) across all three assessment categories, with strongest results in community 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 positive in both study arms.
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.
Jhpiego 在加纳西部地区的六个沿海地区实施了一个为期五年的项目，以加强社区为基础的卫生规划和服务（CHPS）模式。该项目采用了质量改进方法（基于标准的管理和认可[ SBM-R ]）来加强 CHPS 模式的实施一致性。本文介绍了项目结束时的评估结果，该评估比较了干预和对照 CHPS 区的质量、获得护理的机会和护理体验。
一项非等效的、项目结束时的、仅有后测的评估比较了 12 个随机选择的干预区和 12 个匹配的对照区。基于标准的评估数据衡量了三个方面的护理提供情况：社区参与、临床服务以及设施准备和管理。通过对来自选定 CHPS 区的 426 名随机选定的社区成员进行家庭调查，评估了获得护理的机会和护理体验。进行了双变量和多变量分析，以比较干预和对照 CHPS 区在这些措施上的表现。
总体而言，干预区在所有三个评估类别中的达标率（83.6%对 58.8%）均优于对照区，在社区参与方面的表现最强（85.7%对 41.4%）。干预区的受访者接受社区卫生官员家访的可能性是对照区的两倍多，接受社区卫生志愿者家访的可能性是对照区的三倍多，并且更有可能参加健康讲座（41.9%对 27.0%）。在两个研究组中，客户对护理的体验都报告为积极的。
评估结果表明，获得优质护理的机会有所增加；然而，干预区和对照区的客户对护理的体验几乎没有差异。随着加纳和其他国家致力于扩大全民健康覆盖，像 SBM-R 这样的务实方法可能有助于让设施和社区服务提供者以及社区成员参与进来，以改善护理的提供。
