Formerly of Health Service, Accra, Ghana.
University for Development Studies, Tamale, Ghana.
Glob Health Sci Pract. 2022 Sep 15;10(Suppl 1). doi: 10.9745/GHSP-D-21-00763.
Ghana is positioned to become the first country in sub-Saharan Africa to implement universal health coverage based on nationwide expansion of geographic access through the Community-based Health Planning and Services initiative. This achievement is the outcome of 3 decades of implementation research that health authorities have used for guiding the development of its primary health care program. This implementation research process has comprised Ghana's official endorsement of the 1978 Alma Ata Declaration, leading to the institutionalization of evidence relevant to the strategic design of primary health care and national health insurance policies and services. Rather than relying solely upon the dissemination of project results, Ghana has embraced a continuous and systemic process of knowledge capture, curation, and utilization of evidence in expanding geographic access by a massive expansion in the number of community health service points that has taken decades. A multisectoral approach has been pursued that has involved the creation of systematic partnerships that included all levels of the political system, local development officials, community groups and social networks, multiple university-based disciplines, external development partners, and donors. However, efforts to achieve high levels of financial access through the roll-out of the National Health Insurance Scheme have proceeded at a less consistent pace and been fraught with many challenges. As a result, financial access has been less comprehensive than geographical access despite sequential reforms having been made to both programs. The legacy of activities and current research on primary health care and national health insurance are reviewed together with unaddressed priorities that merit attention in the future. Factors that have facilitated or impeded progress with research utilization are reviewed and implications for health systems strengthening in Ghana and elsewhere in Africa and globally are discussed.
加纳有望成为撒哈拉以南非洲第一个实现全民医保的国家，其基础是通过社区卫生规划和服务倡议在全国范围内扩大地理覆盖范围。这一成就源自 30 年来的实施研究，加纳卫生当局利用这些研究来指导其初级卫生保健计划的发展。这一实施研究过程包括加纳正式认可 1978 年《阿拉木图宣言》，从而使与初级卫生保健和国家卫生保险政策和服务的战略设计相关的证据制度化。加纳没有仅仅依靠项目成果的传播，而是采取了一种持续的系统性知识获取、管理和利用证据的过程，通过大规模扩大社区卫生服务点的数量来扩大地理覆盖范围，这一过程已经持续了几十年。加纳采取了多部门的方法，建立了系统的伙伴关系，包括政治系统的各个层面、地方发展官员、社区团体和社交网络、多个基于大学的学科、外部发展伙伴和捐助者。然而，通过推出国家卫生保险计划实现高水平财务覆盖的努力进展较为缓慢，并且面临许多挑战。因此，尽管对这两个项目都进行了改革，但财务覆盖范围不如地理覆盖范围全面。本文综述了初级卫生保健和国家卫生保险方面的活动和当前研究的遗留问题以及未来值得关注的未解决重点。本文还回顾了促进或阻碍研究利用的因素，并讨论了对加纳和非洲乃至全球卫生系统加强的影响。
