Ghana

The Government of Ghana has adopted the WHO focused antenatal care (ANC) package in a move to improve access, quality and continuity of ANC services to pregnant women. As part of these efforts, the Government has exempted fees for ANC clients. The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service (GHS), FRONTIERS, and with USAID funding, was to examine the extent to which adaptation of the package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The study used a policy analysis and a situation analysis in ten intervention clinics in which the package had been introduced and four comparison clinics.

The original purpose of the ADHA scheme was to compensate doctors for hours worked beyond the standard 40 hours per week or 160 hours per month. This study investigated how the scheme impacted a number of human resources (HR) factors associated with health worker recruitment, deployment, retention and performance - specifically, how the significantly higher income levels resulting from the ADHA scheme influenced job satisfaction, motivation, workplace climate and the relationship between clinical and administrative staff, as well as productivity. The study provides a detailed chronology of the ADHA scheme and explores lessons learned from the way in which the GOG implemented and administered the scheme.

A comparison showed that two models for teaching maternal care skills to providers resulted in similarly modest improvements in knowledge and performance. However, maternal care skills remained weak overall. Training should incorporate the best elements of the two approaches while seeking improvements in basic knowledge of maternal care. [author’s description]

Community-based Health Planning and Services (CHPS) initiative as a strategy to deliver community level service is a key health system reform for the Health Sector in general and the Ghana Health Service in particular. If the health sector is to achieve the Health Millennium Development Goals’ in Ghana, then there is the need for a drastic shift in the paradigm of service provision. CHPS provides us with a vehicle for making this paradigm shift so as to deliver community level service by engaging communities in taking decisions concerning their own health and recognizing that the primary producers of health are the individuals within households – especially mothers.

Outline of the community-based health planning and services (CHPS) initiative developed by the Ghana Health Services, as an enhanced Close to Client (CTC) System. CHPS aims to provide accessible primary health care to all communities of Ghana, by enabling District Health Management Teams throughout Ghana to develop approaches to community health care that are consistent with local traditions, sustainable with available resources, and compatible with prevailing needs. This article discusses, step by step, the processes involved in managing, planning, coordinating, and monitoring the CHPS initiative.

The Christian Health Association of Ghana (CHAG) is a large faith-based NGO which currently serves an estimated 35 percent of the Ghanaian population, mainly in remote rural areas. CHAG’s financial sustainability is threatened due to declining donations from missionary groups and donor agencies, uncertain support from government, and low cost recovery in member facilities. Although knowledge of costs is essential to program management, CHAG members had no information on the costs of the services they provided. Thus, CHAG had no economic benchmarks for evaluating efforts to control costs, no denominator for calculating cost recovery for different services, and no empirical data on service costs that could be used to approach donors and the Ghanaian government with requests for funding.

This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralziation: deconcentration, delegation and devolution. The second framework uses a principle agent approach and innovative maps of decision space to define the range of choice for different functions that is transferred from the centre to the periphery of the system. [from abstract]

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It describes an incentive scheme to help retain certain critical staff in the rural areas and to attract health workers to areas with inadequate staff.


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This article discusses the issue the brain drain of doctors to more developed countries and Ghana’s efforts to supply an adequate health workforce in the face of this problem.

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It discusses health labor force dynamics including how traditional workforce planning does not consider key issues, incentive issues and mapping workfoce productivity in Ghana.


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This report presents the child mortality impact of a trial of primary healthcare service delivery strategies in rural Ghana. After adjustment for sociodemographic factors, underfive mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. [from abstract]

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration.

The involvement of district-level workers in local-level practical approaches to mainstreaming gender is central to facilitating change and informing health strategies. There are very few practical examples of mainstreaming gender in health, especially at the lower levels of the health sector. One approach is to build the capacity of staff to conduct and respond to gender analysis. [author’s description]

This study seeks to describe the existing systems for measuring and monitoring staff performance in the clinical setting and covered public and para-statal hospitals in Ghana. [author’s description]

An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. The Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources, and cultural institutions for supporting community-based primary health care.

The Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces.

This document evaluates the Support and Treatment for Antiretroviral Therapy project (START) program, a joint initiative of Family Health International (FHI) and the Government of Ghana, to integrate antiretroviral therapy into comprehensive care for people living with HIV/AIDS in Ghana. START helped establish voluntary counseling and testing centers, prevention of mother-to-child transmission activities and clinical care services. Key components of the START program include home-based care (HBC), referral networks and linkages to such existing services as spiritual and social support, and support for orphans and other vulnerable children (OVC).

Ghana addresses its serious health workforce shortage and consequent issues with health service delivery through a new human resources strategic plan developed to guide scale-up from 2007 to 2011. [from abstract]

This document evaluates the expected change in the reproductive preferences of women due to the presence of volunteers and community health workers providing health service delivery in the communities through the Community Health and Family Planning project. In the communities where there is intervention, women seem to show that their fertility preferences are generally shifting towards small family sizes although the fertility levels are still high. [adapted from author]

Ghana, a low income developing country, is undergoing health sector reforms aimed at achieving greater equity of access to services, improved efficiencies in resource utilization, development of wider linkages with communities and other partners, as well as improved quality of health services. These reforms have strong influences on, and are influenced by, issues of human resources development, deployment and motivation. Some of the human resources issues debated under the reforms include issues of distribution of personnel, reprofiling of staff types and skill mixes including delegation of some essential skills.

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It describes the Health Workforce Observatory’s purpose to “bring together stakeholders involved in HR for Health at country level to collect, collate, process, analyze and disseminate evidence based HR information for HR development and networking at country and sub regional levels for health improvement.” It outlines the strategies from a country level and international level including stakeholders and support.


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This paper is a desk study which looks at experiences of integrating vertical health programmes into national delivery systems where government and donors have adopted a sector wide approach (SWAp) to supporting health sector reform. It was commissioned to facilitate decision making in SDC regarding future possible integration of the Tanzania Tuberculosis and Leprosy Programme into national delivery systems and the SWAp process.[author’s description]

Whilst the issue of international migration of health workers is sometimes presented as a one-way linear ‘brain drain,’ the dynamics of international mobility, migration and recruitment of health workers are complex. Against this complex backdrop, the main objectives of this paper, drawing from the terms of reference, are: to examine trends in the inflow of health workers to the UK; to examine the methods used in the international recruitment of health workers to the UK; to report on the Department of Health Code of Practice; to provide case studies in the impact of outflow of health workers from developed countries (Ghana and Barbados); and to discuss the international policy context of health workers recruitment and migration and identify current knowledge gaps for future research.

This report documents the assessment of a family planning training program for providers to enable them to offer family planning counseling and methods, and make referrals where needed as part of antiretroviral therapy services in Ghana. [from summary]

Universal Basic Precautions (UBP) are not well understood nor implemented by health professionals, though crucial in HIV/AIDS prevention. UBP refers to the prevention of transmission of blood borne pathogens like HIV through strict respect by health workers of rules concerning care and nursing. The objectives of this study were to find out knowledge and attitudes of medical personnel doctors in the Department of Surgery of the Korle Bu Teaching Hospital to HIV transmission and to find out their current practices of UBP in surgery. This study shows the need for the Ministry of Health, the Ghana Health Service and its institutions to develop and implement specific policies on the practice of UBP, training of health care providers and ensuring the consistent supply of protective materials.

JHPIEGO’s strategies for strengthening Ghanaian preservice education in family planning/reproductive health and essential maternal and neonatal care have included: developing and implementing a standardized, competency-based curriculum; improving knowledge and skills of tutors and clinical trainers/preceptors; reinforcing service delivery sites used for clinical practice; and providing schools and clinical training sites with anatomic models and supporting training materials. [adapted from author]


This report evaluates the success of the training program at 12 midwifery training schools.

This is an exploratory descriptive study that examined migration of locally trained doctors from Ghana using graduates of the country’s first medical school as a proxy. The objectives of the study were to describe trends in the loss of medical personnel to emigration and the influence this has on human resources planning, including forecasting of staff supply and requirements. It was also to provide some information towards the development of strategies to counteract such losses. [from abstract]

This report presents findings of a study on the migration of health professionals in Cameroon, Ghana, Senegal, South Africa, Uganda and Zimbabwe. The report provides detailed information about migration patterns and numbers, reasons for migration, effects on the quality of health care and the policies being undertaken in the respective countries to reduce outward migration. [from executive summary]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It outlines the micro-economics of health worker behaviour and discusses a study done to evaluate migration in Ghana.

When Ghana published its National Reproductive Health Service Policy and Standards (NRHSPS) document in April 1996, the curricula of Ghana’s two established medical schools-University of Ghana Medical School (UGMS), Accra, and School of Medical Sciences, University of Science and Technology (SMS/UST), Kumasi-had not been reviewed for several years. In addition, graduating physicians had not been assessed to determine whether they had the skills to meet Ghana’s present reproductive health (RH) needs. This technical report describes a needs assessment of Ghana’s preservice medical training conducted at these two schools in August 1996 by JHPIEGO in collaboration with the medical schools and the Maternal Child Health/Family Planning (MCH/FP) Unit and the Human Resources Development Division (HRDD) of the Ministry of Health (MOH).