Piloting preferred primary health care provider networks will provide lessons for scaling up sustainable, high-quality, equitable, and affordable health care in Ghana.
The Challenge
Independent evaluations of past health system interventions in Ghana show three significant barriers to the delivery of primary health care (PHC) nationwide: inefficient provider payment mechanisms, inadequate and inconsistent capacity to deliver the basic package of PHC services, and fragmented administration and referrals. These barriers lead to high variability in the quality of and access to PHC, especially among low-income populations. The Ministry of Health and Ghana Health Service established Community-Based Health Planning and Services (CHPS) as an approach to improve access to PHC, and National Health Insurance Scheme members are encouraged to register with the CHPS center closest to them. However, the quality and capacity of health service delivery at the CPHS level remain highly variable and patients are hesitant to register with CHPS due to inconsistent service delivery.
The Opportunity
Provider networking has been suggested as one innovative solution to address health system barriers in Ghana. International evidence suggests that networks can significantly improve the delivery of PHC service by reducing fragmentation in financing, payment, and administration, coordinating referrals and services, ensuring accessible PHC for diverse communities, and leveraging limited funds to maximize performance at all levels of the health system. The formation of provider networks requires an initial investment in management capacity, agreement among all participating providers on the terms of networking, and community mobilization to enroll with and seek care from networks.
Ghana’s health system is well-suited for provider networking, but most providers lack incentives and the requisite knowledge to organize and operationalize group practice. At the lowest level of the health system, CHPS zones provide a logical unit for a provider network. Networking between CHPS and health centers (both public and private) will enable providers to efficiently distribute resources and allow patients to access health care from the network member best suited to address their individual needs. By formalizing relationships among different levels of service provision, strengthening data and financial management systems, and clarifying administrative and referral relationships, the pilot provider networks have the potential to affect multi-level health reforms that strengthen systems and improve care for patients.
Our Work
R4D is working with Ghana Health Service, the National Health Insurance Authority, Ministry of Health, and University Research Co., LLC (URC) on the USAID-supported Systems for Health (S4H) program in Ghana to pilot preferred primary health care provider networks in two districts in Volta Region.
The network pilot will test network models and referral arrangements that will enable CHPS to thrive. The pilot aims to strengthen the health system for PHC delivery and make policy and operational recommendations about the roles primary health care provider networks can play in improving PHC services, as well as the enabling conditions for networks to succeed.
Through 2019, R4D is conducting the following activities:
- Establishing the pilot design with a multi-sector technical working group that includes public and private sector stakeholders such as the Ministry of Health, Ghana Health Service, the National Health Insurance Authority, and the Christian Health Association of Ghana (CHAG),
- Investing in the capacity of networks through financial and administrative management training,
- Overseeing the formation of PPP networks, including credentialing and registration,
- Supporting development of guidelines for network arrangements and management,
- Strengthening performance monitoring and management among participating health managers and providers,
- Monitoring and analyzing performance, including changes in health outcomes, resource allocation, equitable access to and utilization of services, quality of care, capacity of providers, referral rates, and efficiency of payment flows,
- And evaluating pilot performance to make policy recommendations.
This work is being done in close coordination with national governing bodies, regional and district-level government counterparts, implementing partners, local public and private sector providers, and donors to ensure alignment and sustainability.
