2025-01-12-世界银行-加纳城市实践网络_设计与实施——阿亚瓦索中心和阿特维马·恩瓦比亚加市形成性研究的关键经验教训（英）_12页_1mb

Networks of Practice in Urban Ghana: Design and Implementation Summary

Urban Ghana presents distinct health system characteristics compared to rural areas, including higher population density, greater prevalence of private health facilities, and higher out-of-pocket expenditure (OOPE) on healthcare. The Networks of Practice (NoP) program, structured with a hub-and-spoke model, aims to improve equitable and affordable primary care, but urban adaptation requires customization due to local care delivery landscapes.

Key findings from formative research in Ayawaso Central and Atwima Nwabiagya Municipal include:

• Strong patient preference for private clinics and hospitals, leading to higher OOPE, with average childbirth costs ranging from 75 to 1,337 Ghana Cedis.
• Physical access to facilities is easier in urban areas, but patients often bypass primary care hubs, preferring convenience and perceived quality of care.
• Geographic analysis shows compact networks with potential for overlapping catchment areas, necessitating detailed spatial planning, supply chain management, and outreach strategies.
• High utilization of non-government providers for condition management, especially hypertension, highlighting the need to include all health facility types in network design.

Lessons and recommendations emphasize the importance of:

• Tailoring NoP designs to urban settings by upgrading selected public hubs and enhancing collaboration with private providers through partnerships like public-private partnerships (PPPs) and data sharing.
• Implementing monitoring systems that incorporate private facilities and exploring ways to reduce OOPE, such as expanding health insurance coverage and improving emergency transport.
• Ensuring operational continuity through initial staff training and ongoing mentorship, adapted to the urban context.
• Pre-piloting in various urban settings to test network mechanisms and learn from local specifics, such as institutional capacities and financing.

The NoP expansion in urban areas must integrate these insights, possibly requiring field-specific mechanisms to address the dominance of private health services and ensure sustainable health system strengthening for equitable access to quality care.