Navrongo community health and family planning project : lessons learned 1994-1998 [-- Ghana]

Chapters describe the experimental design of the study, the social setting, and constraints on reproductive change, findings from the implementation of the pilot phase of the study, and project impact on FP use and fertility. Preliminary results indicate that the project is having an impact on reproductive motives, contraceptive behavior, and fertility. The project has undertaken extensive work on integrating RH services into the regimen of rural health services in the Kassena-Nankana District of northern Ghana. Results of this effort are described. The report concludes with a summary of lessons for Ministry of Health policy, possible strategies for scaling up elements of the experiment into a national community health and FP program, and implications for international health and population policy. Key lessons include the following: (1) Despite economic and social conditions that are unfavorable to the introduction of FP, fertility will decline if programs are appropriately designed and sensitive to cultural conditions and needs. When communities are consulted about their preferences, they provide advice on the management of care and communication strategies that is crucial to the design of community health care. Mobilizing all sectors of the society at the peripheral level (community systems, health care systems, and political systems) contributes to sustainability and impact. Communities will donate labor, leadership, and materials if the health program provides training, technology, and clinical expertise. (2) An integrated approach to service delivery (health and FP) is more desirable than a categorical delivery of component services. Although the design of the experiment does not specify treatments to evaluate this proposition, baseline social research indicated that the demand for health care was so prominent that there was no point in testing the integration hypothesis. The case for delivery of integrated services was made repeatedly and powerfully by all age groups, both genders, and by leaders of communities to be served by the project. When an integrated service package was implemented at the village level by a multi- purpose provider working with community institutions, more health service was provided than is provided at fixed "Level B" facilities. The integrated approach of the CHFP involves the health and FP service regimen described in chapter 2. (3) A system-wide approach is more appropriate for developing operations than a component approach. The CHFP project identified problems affecting the health sector as a whole. It did not set up parallel systems and vertical service delivery structures that would be difficult to replicate. At all stages in this investigation, the CHFP has operated as a complete model health service delivery system. (Author abstract, modified)