Guiding the Ghana community-based health planning and services approach to scaling up with qualitative systems appraisal

When a Navrongo Health Research Centre experiment demonstrated that community-based health services could reduce child mortality and fertility in impoverished communities, the Government of Ghana launched the Community-based Health Planning and Services (CHPS) Initiative to scale up results. This article reports on a "Qualitative Systems Appraisal" (QSA) of factors explaining why CHPS is implemented in some districts, but stalled in others. QSA consists of groups representing levels of the service hierarchy (community members, frontline service providers, supervisors, and district managers) to portray systemic reactions to CHPS. Community members are enthusiastic about CHPS and willing to mobilize labor and resources for constructing nurse accommodations. Participating staff are supportive, but staff not yet participating are apprehensive about the program. Nurses worry about their transfer to communities; supervisors and managers worry about constrained fuel, equipment, drugs, facilities, and manpower resources. Demonstrating CHPS at functioning sites clarifies ways to bridge resource gaps, address concerns, and build consensus for the implementation process.