Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.
School of Public Health, CK Tedam University of Technology and Applied Sciences, Navrongo, Ghana.
BMC Pregnancy Childbirth. 2023 Apr 28;23(1):298. doi: 10.1186/s12884-023-05577-7.
This paper reports on results of a health system strengthening implementation research initiative conducted the Upper East Region of northern Ghana. Transformative interventions to accelerate and strengthen the health delivery were implemented that included empowering community leaders and members to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, providing basic medical equipment to community clinics, and improving the skills of critical health staff through training.
A mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. To assess impact, a pre-versus-post randomized cluster survey design was used. Qualitative research was conducted with focus group data and individual in depth interviews to gauge the views of various stakeholders associated with the implementation process.
After intervention, significant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage were observed and increases in the proportion of deliveries occurring in health facilities and assisted by skilled health personnel relative to pre-intervention conditions. There was also increased uptake of oral rehydration salts (ORS) for treatment of childhood diarrhoea, as well as marked reductions in the incidence of upper respiratory infections (URI).
A pre-and post-evaluation of impact suggests that the programme had a strong positive impact on the functioning of primary health care. Findings are consistent with the proposition that the coverage and content of the Ghana Community-based Health Planning and Services programme was improved by program interventions and induced discernable changes in key indicators of health system performance.
本文报告了在加纳北部上东部地区进行的一项卫生系统强化实施研究计划的结果。实施了变革性干预措施，以加速和加强卫生服务，包括授权社区领导人和成员积极参与卫生服务，通过提供社区交通系统来加强转诊系统，向社区诊所提供基本医疗设备，并通过培训提高关键卫生人员的技能。
采用混合方法设计评估干预措施的影响。定量评估采用灵活的研究设计来测试项目各个组成部分活动的效果。为了评估影响，采用了预-后随机集群调查设计。定性研究采用焦点小组数据和个人深入访谈进行，以衡量与实施过程相关的各种利益相关者的观点。
干预后，关键母婴健康指标如产前和产后护理覆盖率显著提高，与干预前相比，在卫生设施分娩并由熟练卫生人员协助的分娩比例增加，儿童腹泻治疗中口服补液盐（ORS）的使用率也有所增加，上呼吸道感染（URI）的发病率明显降低。
对影响的预-后评估表明，该方案对初级卫生保健的运作产生了强烈的积极影响。研究结果与以下观点一致，即加纳社区卫生规划和服务方案的覆盖范围和内容通过方案干预得到改善，并在卫生系统绩效的关键指标上引起了明显变化。
