2025-01-12-世界银行-加纳的实践网络_从两个地区的实施中学习——Dormaa_Central和Hohoe地区研究的主要经验教训（英）_12页_1mb

NETWORKS OF PRACTICE IN GHANA: Implementation Insights

Two districts, Dormaa Central (USAID/R4D 2020) and Hohoe (KOFIH 2021), were studied via Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to assess the impact of Networks of Practice (NoP) on healthcare delivery.

Key Insights

• Key NoP Features: NoPs use a hub-and-spoke model (hub: Model Health Centre), varying spoke compositions (other health centres, CHPS posts, pharmacies). Ghana Health Service initiated the PCPN program aiming for equity, collaboration, and community engagement.
• Data Methods: Research combined quantitative (PPA, SNA, health facility/service provider surveys) and qualitative methods, comparing NoP and non-NoP districts through district matching.
• Positive Impacts: Observed facility improvements, service enhancements, increased collaboration, better resource sharing, improved trust, and increased awareness of the hub spoke model.
• Barriers/Challenges: Weak referral gatekeeping (despite guidelines), direct referrals from CHPS to hospitals, poor community engagement despite CHMC structures and scorecards, limited cross-facility/explicit partnerships with private sector, spatial accessibility issues, insufficient hub capacity/infrastructure, staff unawareness/information gaps.
• Stated Benefits by Providers: Reported enhanced teamwork, improved workload distribution, reduced hospital burden, improved service delivery at spoke facilities, increased referrals to hubs, quality improvement indicators.
• Patient Preference: Facility selection driven primarily by perceived quality and proximity, rather than affordability specifically (despite OOPE being an issue). Willingness to travel/facilitate costs for higher quality care.

Recommendations for Scaling Up

• Enhanced HR Monitoring & Resourcing: Ensure hubs and spokes have norm-compliant staffing, regular review meetings, training, and district oversight.
• Patient Centred Mapping & Advocacy: Map all nodes in patient pathways, including pharmacies, run awareness campaigns about available services at hubs.
• Systematic Review & Collaboration: Institutionalize regular review meetings, strengthen internal and external collaborations through diverse communication channels, engage community actively.

Conclusion

The NoP intervention represents a substantial systemic change requiring continuous investment and mentoring. While successful in structure and raising awareness, challenges in referral flow, collaboration, and resource management must be addressed before full impact is achieved during national scale-up.