The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana
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Date
2019-05-23
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
Background
The Ghana Health Service in collaboration with partner institutions implemented a five-year
primary health systems strengthening program known as the Ghana Essential Health Intervention
Program (GEHIP). GEHIP was a plausibility trial implemented in an impoverished
region of northern Ghana around the World Health Organizations (WHO) six pillars combined
with community engagement, leadership development and grassroots political support,
the program organized a program of training and action focused on strategies for
saving newborn lives and community-engaged emergency referral services. This paper
analyzes the effect of the GEHIP program on child survival.
Methods
Birth history data assembled from baseline and endline surveys are used to assess the hazard
of child mortality in GEHIP treatment and comparison areas prior to and after the start of
treatment. Difference-in-differences (DiD) methods are used to compare mortality change
over time among children exposed to GEHIP relative to children in the comparison area over
the same time period. Models test the hypothesis that a package of systems strengthening
activities improved childhood survival. Models adjusted for the potentially confounding effects
of baseline differentials, secular mortality trends, household characteristics such as relative
wealth and parental educational attainment, and geographic accessibility of clinical care.
Results
The GEHIP combination of health systems strengthening activities reduced neonatal mortality
by approximately one half (HR = 0.52, 95% CI = 0.28,0.98, p = 0.045). There was a nullincremental effect of GEHIP on mortality of post-neonate infants (from 1 to 12 months old)
(HR = 0.72; 95% CI = 0.30,1.79; p = 0.480) and post-infants (from 1 year to 5 years old)
-(HR = 1.02; 95% CI = 0.55–1.90; p = 0.940). Age-specific analyses show that impact was
concentrated among neonates. However, effect ratios for post-infancy were inefficiently
assessed owing to extensive survival history censoring for the later months of childhood.
Children were observed only rarely for periods over 40 months of age.
Conclusion
GEHIP results show that a comprehensive approach to newborn care is feasible, if care is
augmented by community-based nurses. It supports the assertion that if appropriate mechanisms
are put in place to enable the various pillars of the health system as espoused by
WHO in rural impoverished settings where childhood mortality is high, it could lead to accelerated
reductions in mortality thereby increasing survival of children. Policy implications of
the pronounced neonatal effect of GEHIP merit national review for possible scale-up.
Description
Research Article
Keywords
Survival, Ghana, Health Interventions Program, plausibility trial
Citation
Bawah AA, Awoonor-Williams JK, Asuming PO, Jackson EF, Boyer CB, Kanmiki EW, et al. (2019) The child survival impact of the Ghana Essential Health Interventions Program: A health systems strengthening plausibility trial in Northern Ghana. PLoS ONE 14(6): e0218025. https://doi. org/10.1371/journal.pone.0218025