Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 
https://doi.org/10.1186/s12961-018-0350-9
RESEARCH Open Access
A review of the process of knowledge
transfer and use of evidence in
reproductive and child health in Ghana
Gordon Abekah-Nkrumah1* , Sombié Issiaka2, Lokossou Virgil2 and Johnson Ermel2
Abstract
Background: The paper carries out a situational analysis to examine the production, dissemination and utilisation
of reproductive and child health-related evidence to inform policy formulation in Ghana’s health sector.
Methods: The study used Wald’s model of knowledge production, transfer and utilisation as a conceptual model to
collect relevant data via interviews and administration of questionnaire to a network of persons who either
previously or currently hold policy-relevant positions in Ghana’s health sector. Additional data was also gathered
through a scoping review of the knowledge transfer and research utilisation literature, existing reproductive and
child health policies, protocols and guidelines and information available on the websites of relevant institutions in
Ghana’s health sector.
Results: The findings of the study suggest that the health sector in Ghana has major strengths (strong knowledge
production capacity, a positive environment for the promotion of evidence-informed policy) and opportunities
(access to major donors who have the resources to fund good quality research and access to both local and
international networks for collaborative research). What remains a challenge, however, is the absence of a robust
institutional-wide mechanism for collating research needs and communicating these to researchers, communicating
research findings in forms that are friendlier to policy-makers and the inability to incorporate funding for research
into the budget of the health sector.
Conclusion: The study concludes, admonishing the Ministry of Health and its agencies to leverage on the existing
strengths and opportunities to address the identified challenges.
Keywords: Knowledge transfer, Evidence, Reproductive and child health
Background optimal allocation and fair distribution of resources, responds
Evidence-based practice or evidence-informed policy-making to scientific and technological advances and consequently
generally refers to systematic efforts to ensure that research improves health outcomes [5]. Indeed, there are a couple of
evidence becomes an important input into policy-making high profile documents that have emphasised the importance
[1]. This has variously been referred to as knowledge transla- of evidence-based policy/knowledge transfer in the health-
tion, knowledge transfer, knowledge exchange, research util- care arena. For example, WHO and the Lord Darzi report
isation, implementation, diffusion and dissemination [2]. on England National Health Service have all emphasised the
Evidence-informed policy-making has assumed increased im- need for closer collaboration between users and producers of
portance in several arenas of policy-making [3, 4]. In the area evidence to ensure that practice is evidence informed [6].
of health policy, the weight placed on evidence-informed The idea that virtually all forms of policy should be based
policy is even much greater, with the reason that it leads to on strong scientific evidence can be traced to the establish-
ment of the evidence-based medicine (EBM) framework. At
the core of EBM is the use of clinical evidence (resulting
* Correspondence: gabekah-nkrumah@ug.edu.gh
1Department of Public Administration and Health Services Management, from scientific research) to guide clinical practice. The
University of Ghana Business School, P. O. Box 72, Legon, Accra, Ghana growth of EBM has transcended clinical practice and
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 2 of 29
greatly influenced the call for non-clinicians (policy-makers, Although Ghana’s investment in health has improved
government officials and programme managers) to aban- over the years and is regarded as one of the best in the
don policy development approaches that rely heavily on sub-Saharan African region, it compares unfavourably to
common sense, popular support and political ideology in other developing countries. For example, health expend-
favour of approaches that are primarily based on scientific iture (HE) as a percentage of Gross Domestic Product
facts/evidence generated through appropriate and robust (GDP) and HE per capita increased from 3% in 2000 to
scientific research. It is not uncommon for discussions 5.4% in 2013 and USD 82.4 in 2000 to USD 214.2 in 2013,
about evidence-informed policy to generate debate about respectively. Ghana’s HE as a percentage of GDP and HE
what constitutes evidence. Generally, evidence can be oper- per capita in 2013 compares favourably to Kenya (4.5% and
ationalised to mean facts (actual or asserted) gained USD 44.5), Nigeria (3.5 and USD 115), The Gambia (6%
through observation or experiences and used to support a and USD 28.9), Uganda (9.8 and USD 59.1) and Mali (7.1
conclusion [7]. The National Institute for Health and Clin- and USD 53.3). Although Rwanda’s HE as a percentage of
ical Excellence (NICE) further argues that evidence can ei- GDP is 2.5 percentage points higher than Ghana, their HE
ther be scientific or colloquial [8]. According to NICE, per capita of USD 83 is lower compared to Ghana [20].
scientific evidence arises from explicit (codified and propos- Ghana’s health sector has witnessed appreciable pro-
itional), systematic (use of transparent and unambiguous gress in several areas over the last one and half decades.
methods for codification), and replicable (use of methods Although Ghana did not meet the Millennium Develop-
that can reproduce results in similar circumstances) scien- ment Goals target on maternal and child health (i.e.
tific methods. On the contrary, colloquial evidence arises MDGs 4 and 5), key outcome indicators in the area of
from expert testimony or comments from practitioners and reproductive and child health (RCH) have improved,
stakeholders that may be crucial in complementing scien- such as a reduction in the national maternal mortality
tific evidence. Within the innovation literature, evidence is rate of 49%, from 760/100,000 live births in 1990 to 380/
also argued to include experiences or received wisdom of 100,000 live births in 2013 [21]. Indeed, Ghana’s 2013
individuals [9]. It is important however to emphasise that, maternal mortality rate can be considered very low com-
among the different facts used to support a policy or con- pared to that of neighbouring or other African countries
clusion, the most reliable is argued to be scientific evidence such as Nigeria (560/100,000), Niger (630/100,000) and
[10–12]. It is therefore not surprising that stronger health Sierra Leone (1100/100,000) over the same period [21].
systems around the world (both developed and developing) Consumption of reproductive health inputs has also im-
are believed to be those whose health policies are informed proved tremendously. The report of the 2014 Ghana
by high quality scientific research evidence [1, 5]. Demographic and Health Survey (GDHS) suggested that
Notwithstanding the importance of using scientific re- the percentage of women receiving antenatal care from a
search evidence to guide the formulation and implementa- skilled provider increased from 82% in 1988 to 97% in
tion of health policies, there is evidence in the research 2014, with the attendance of four or more antenatal
utilisation literature to suggest the existence of a major gap visits also increasing from 78% in 2008 to 87% in 2014
between available research evidence and actual practice (i.e. [22]. In addition, 78% of women having given birth in
health policy and clinical practice) [13]. The research the 5 years preceding the 2014 GDHS received protec-
evidence to utilisation gap is much worse in low- to tion against neonatal tetanus, with women delivering in
middle-income countries, partly due to weak capacity a health facility increasing from 42% in 1988 to 73% in
(skill set and systems) to carry out policy-relevant re- 2014. The GDHS 2014 report also suggested that 8 in 10
search and ability to translate research findings into a mothers received postnatal check-up within the crucial
form that can be easily utilised by policy-makers [14]. first 2 days after delivery.
Besides the issues of capacity, the underdeveloped na- Infant and child health has also improved over the
ture of health systems in low- to middle-income years. For example, infant mortality and under-five mor-
countries such as Ghana, coupled with the generally tality have declined by 28% and 44%, respectively, for the
low levels of investments in health, may also be respon- period 1998 to 2014. Additionally, the 2014 GDHS sug-
sible. At the micro level, it is equally argued that the pro- gested that neonatal mortality and perinatal mortality
pensity of healthcare organisations to use research stood at 29/1000 and 38/1000 live births, respectively,
evidence in policy is determined by their ability to put in and that the percentage of children with basic vaccin-
place formal and informational structures that drives or- ation coverage increased from 47% in 1998 to 77% in
ganisational learning and norms, and value the import- 2014. Although the percentage of children (aged 12–
ance of evidence in decision-making [15–19]. The micro 23 months) with low birth weight (less than 2.5 kg) is
and macro level weaknesses enumerated above may pos- 10%, children under-five who are stunted, wasted or
sibly explain the low utilisation of research evidence in underweight dropped from 35%, 8% and 18%, respectively,
health policy-making in many developing countries. in 2003 to 19%, 5% and 11%, respectively, in 2014 [22].
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 3 of 29
The substantial progress made in Ghana’s health sector has determine what constitutes an appropriate model [39]. Be-
often been linked to the adoption of sector-wide approaches sides, several of these models are mostly unrefined and
in the 1990s, which ushered in systematic approaches to pol- untested, thereby raising justifiable questions about their
icy formulation and implementation in Ghana’s health sector suitability for use in the design and evaluation of know-
[23–25]. For example, the formulation and implementation ledge transfer interventions or understanding the research
of comprehensive and robust medium-term plans (i.e. the utilisation process [6]. A key criticism of most of the exist-
5-Year Programme of Works (POWs)), starting from 1997 ing models is that they are very narrow and hardly cover
to date, are all products of the Ghana sector-wide the broader sociological processes in knowledge transfer
approaches. There have been four 5-Year POWs (i.e. 1997– [6].
2001, 2002–2006, 2007–2011 and 2014–2017) since 1997. To better understand the process of knowledge trans-
Most importantly, the POWs meant the formulation of fer and use of evidence in decision-making, a framework
programme-specific policies (for example, RCH) to achieve that captures the broader sociological explanation of
the objectives of the POWs at the national level. knowledge transfer and use of research evidence has re-
What is clear and unambiguous about the POWs and cently been developed based on a comprehensive sys-
other programme-specific policies (i.e. RCH policies) in the tematic review of the existing knowledge transfer
health sector is the clear, transparent, participatory and ro- literature [6]. Although the framework has not been em-
bust processes used in their development. On the contrary, pirically tested just as a large chunk of those before it,
the extent to which these policies are informed by existing its appeal arises due to the fact that it is recent and
scientific research evidence is either unclear or has rarely fea- tends to combine the components of 28 different models
tured in Ghana’s health policy literature. The current paper that either wholly or partly explains the process of
therefore carries out a situational analysis to examine the knowledge transfer [6]. The framework is made up of
process of knowledge production, transfer and use of scien- five components as explained below (Fig. 1).
tific research evidence in the formulation of RCH policies in
Ghana. For the purposes of this paper, RCH is defined to 
 Problem identification and communication – This
cover maternal, newborn and child health (MNCH). deals with channels used by users to communicate
problems to researchers.
Conceptual model 
 Knowledge/research development and selection –
The knowledge transfer and innovation diffusion litera- This deals with the knowledge or research to be
ture abounds in several theoretical frameworks that aim transferred and attributes or characteristics that will
to explain the process of knowledge transfer and eventual enhance successful transfer of knowledge. Within the
use of knowledge [14, 26–28]. For example, Roger’s Diffu- literature, key activities considered to be crucial at this
sion of Innovations theory has been used extensively in stage of the knowledge transfer process include
the last 20 years to explain the process of transferring producing, synthesising and adapting to new
knowledge into practice, especially in clinical practice, knowledge.
healthcare organisations and in health policy-making [29]. 
 Analysis of context – This is part of the knowledge
In addition, several authors, through systematic reviews of transfer process and looks at factors that may
the existing knowledge transfer and research utilisation lit- constrain or promote the transfer of knowledge.
erature [30–36], have developed conceptual frameworks 
 The knowledge transfer activity or intervention –
meant to explain the process of knowledge transfer and This is often the most common component of the
utilisation of research evidence in decision-making. Evi- knowledge transfer process and involves the actual
dence from recent systematic reviews suggest the exist- activities undertaken to transfer knowledge.
ence of as many as 63 different theoretical models and 
 Knowledge/research utilisation – This looks at the
frameworks on knowledge transfer from fields such as actual use of knowledge or research findings transferred.
healthcare, social care and management [26, 37]. There is
also a section of the knowledge transfer/research utilisa- The order in which the components of the framework
tion literature that has focused on examining factors are listed does not in any way suggest that they happen in
(knowledge characteristics, organisational characteristics, a linear fashion. The proponents of the framework argue
environmental characteristics, individual characteristics, that knowledge transfer does not happen in a linear fash-
etc.) that predict, facilitate or hinder the utilisation of ion, but in a complex, dynamic and multidirectional fash-
research evidence [6, 28, 38]. Notwithstanding the abun- ion [6]. This view has support in the existing literature, in
dance of theories and frameworks on knowledge transfer that researcher to policy-maker interactions constitute a
and research utilisation in this literature, the diverse na- key ingredient to successful knowledge transfer [40, 41].
ture and sheer depth of this literature makes it extremely However, for simplicity and application to RCH in Ghana,
difficult for practitioners and researchers alike to our analysis will be conducted as if the process occurs in a
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 4 of 29
Fig. 1 Knowledge Transfer and Research Utilisation Framework (KTRUF). Source: Constructed based on Ward et al. [6]
linear form. Thus, the above five-component framework research centres (https://mamaye.org/welcome-e4a-ma-
will constitute the basis for examining processes for the maye), a popular website with informative content on
production, transfer and use of research evidence to in- RCH issues in Ghana and other West African countries
form RCH policy formulation in Ghana. was also reviewed. Additionally, RCH-related literature
on Ghana was reviewed to gather evidence on the cap-
Methods acity of Ghana’s health sector to generate scientific evi-
Using a qualitative research method, the paper conducts a dence to support policy-making in RCH. This was done
situational analysis of the process of knowledge transfer via a search through recognised public health-related da-
and utilisation of research evidence to inform RCH policy tabases and publishers (BMC, Elsevier, Oxford, PubMed,
in Ghana. Data for the paper was gathered through a African Journals Online and Global Health Archives)
two-stage process. The first stage focused on collecting and Google Scholar using the following search topics:
initial data for analysis. The first step of the first stage (1) knowledge transfer and health policy; (2)
reviewed grey literature (i.e. policies, protocols and prac- evidence-informed health policy; (3) evidence and mater-
tice guidelines; Tables 1 and 2) that could potentially pro- nal health policy in Ghana; (4) evidence and child health
vide information on the use of evidence to inform policy. policy in Ghana; (5) evidence and newborn health policy
This was followed with interviews and discussions with in Ghana; and (6) reproductive and child health inter-
persons who either previously held or currently hold a se- vention scale-up in Ghana.
nior level position (Director, Deputy Director, Programme Based on the above search criteria, peer-reviewed jour-
Officer, etc.) in the GHS or Ministry of Health (MOH). nal articles on RCH published in English since 2000,
The discussions and interviews focused on understanding were retrieved. Overall, 77 out of a total of 534 articles
the capacity of the health sector to produce, disseminate retrieved were selected and reviewed. The 77 were se-
and use research evidence to inform RCH policy. lected on the basis of relevance and are made up of (1)
Additional data was also acquired through the review 39 articles on RCH-related evidence in Ghana with at
of information provided on the website of MOH and its least one author being a staff member of MOH/GHS
agencies, specifically, GHS and related departments. (Table 3); (2) 28 articles on RCH-related evidence in
These include the Navrongo Health Research Centre Ghana authored by researchers outside of MOH/GHS
(NHRC), the Kintampo Health Research Centre (KHRC) (Table 4); and (3) 10 articles on scaling-up of
and the Dodowa Health Research Centre (DHRC). The RCH-related projects in Ghana (Table 5).
website review focused on gathering information on the In the second stage, a draft report based on data col-
capacity of the research centres to produce evidence and lected in the first stage was presented to a meeting of 36
convert the evidence to a form that can easily be used participants drawn from Ghana’s health sector (i.e.
by policy-makers. In addition, the websites of the GHS mainly policy-makers/managers/senior officials within
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 5 of 29
Table 1 Profile and characteristics of policy documents on reproductive and child health in Ghana
S/No Year of publication Title of policy Document source/publisher Main focus of policy Main research/evidence/ Process employed in the policy
publication informing the
policy cited in document
1. Ghana Health Service National Breastfeeding GHS, Accra Improve upon maternal and child No scientific evidence was cited in Developed through expert views
(GHS), 2003 [55] Policy health through the promotion, the document, but other views
protection and support of optimal of professionals were reflected
breastfeeding practices and
appropriate complementary
feeding practices
2. Ministry of Health, Ghana National Newborn Ministry of Health (MOH), Provides a newborn scale-up Employed a scientific evidence- Adopted a detailed desk review of
2014 [56] Health Strategy and Action Accra-Ghana strategy and action plan for based process for policy relevant policy on maternal and
Plan 2014–2018 addressing newborn mortality in development child health system performance in
Ghana Ghana. Data on Household Survey
(DHS, Multiple Indicator Cluster
Surveys) were reviewed. Field visit
was adopted, stakeholders
discussions were initiated
3. Ministry of Health, Under 5 child Health Policy: MOH, Ghana Provides a framework for No academic publication was Developed through consultation
2007 [57] 2007–2015 programme planning, cited in the document of stakeholders’ views and a review
implementation and evaluation of relevant policy documents
geared towards improving child
survival and wellbeing. Provides
standards and guidelines to
prevention and treatment of child
illness
4 Ghana Health Report on the Burden GHS, Ghana Report on the burden of obstetric Employed scientific research Adopted a qualitative research
Service, 2015 [58] of Obstetric Fistula in Ghana UNFPA fistula in Ghana, evidence in the document approach with a survey in
examining personnel capacity in write-up document preparation
managing the condition
5 Ministry of Health, Postpartum Hemorrhage MOH, Accra Provides data on the incidence of Cited some empirical-based Collection of expert views and
2013 [59] Prevention and Management PATH postpartum haemorrhage in Ghana. research stakeholder consultation as well
Strategy for Ghana Establishes a framework and as a review of some relevant
guideline for postpartum institutional policy, reports and
haemorrhage prevention and household survey
management
6 Ministry of Health, Anti-Malaria Drug policy MOH, Accra Provides policy measures and No publication is cited Developed through stakeholder
2007 [60] for Ghana guidelines for the treatment of consultation and expert views
Malaria in Ghana
7 Ministry of Health, National Condom and Ghana AIDS Commission, Establishes a national strategic No publication was cited Collection of information from
2015 [61] Lubricant Strategy Accra framework to promote quality in the document national strategic and action
2016–2020 USAID sexual and reproductive health plan for HIV/AIDS prevention,
UNFPA reproductive health, etc. There
GHS, Accra was a consultation with other
stakeholders
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 6 of 29
Table 2 Profile and characteristic protocols and practice guidelines on reproductive and child health in Ghana
S/No Year of publication Title of policy Document source/publisher Main focus of policy Main research/evidence Process employed in the
publication informing the policy
policy cited in document
1 Ghana Health Service, National Family Planning Ghana Health Service Aims at providing a strategic No empirical evidence was Document was based on
2000 [62] Protocols (GHS), Accra guide to information on family cited in the document expert views and standards
planning methods in Ghana of operating procedure by
professionals
2 Ghana Health Service, National Safe Motherhood GHS, Accra Provides a guideline for No empirical evidence was Based on the views and
2008 [63] Service Protocol Ministry of Health treating and managing cited in the document standard operating procedure
(MOH), Accra pregnancy-related complica- by experts in the field
tions common to caregivers at
all levels
3 Ghana Health Service, Adolescent Health Info Pack GHS, Accra Focuses on the growing No publication cited in the Developed from expert views
2007 [64] UNFPA changes of adolescent document and role play by adolescents
UKaid (biological and social changes) to depict growing changes in
Provides a guide on the risky the adolescent stage
sexual behaviours at the
adolescent stage
4 Ministry of Health, What Every Pregnant Woman MOH, Ghana Provides information on the No empirical evidence cited in Based on the views and
2011 [65] Should Know expectation of every pregnant the document professional experiences of
woman based on the stages experts
of pregnancy
5 UNFPA, 2014 [66] Living with Fistula UNFPA Explore the views and lives of No publication was cited in Collection based on survivors’
fistula survivors the document views, experiences and
funding partners support to
survivors
6 Ministry of Health, Concise Integrated MOH, Accra Provides a strategy for No publication was cited in Based on expert clinical
2010 [67] Management of Neonatal managing childhood diseases the document opinion and expert survey in
and Childhood Illness and a guide for preventing the field of neonatal and child
cause of death health
7 Ghana Health Service, Maternal Health & Death GHS, Accra Aims at providing a framework No empirical evidence was Employed a household survey
2010 [68] Audit Guidelines for improving maternal health cited; however, an institutional method with expert views and
quality and a tool for policy document was cited a review of relevant policy
monitoring maternal deaths in documents
Ghana
8 Ghana Statistical Service, Ghana Maternal Health GHS, GSS Provides empirical evidence Empirical scientific evidence Developed based on a
2007 [69] Survey Inc. Macro on the incidence of maternal was cited in the document household survey, review of
mortality. Establishes the relevant policy document and
prevalence of abortion in stakeholder involvement in the
Ghana and provides guidelines preparation of this document
on antenatal care attendance
in Ghana
9 Ghana Health Service [70] Ghana Health Service GHS, Accra Focuses on providing No scientific evidence was Developed based on view of
Newsletter for Adolescent adolescent with information established in the preparation adolescent and stakeholder
and Young People on adolescence-related of this document consultation
challenges
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 7 of 29
Table 2 Profile and characteristic protocols and practice guidelines on reproductive and child health in Ghana (Continued)
S/No Year of publication Title of policy Document source/publisher Main focus of policy Main research/evidence Process employed in the
publication informing the policy
policy cited in document
10 Ministry of Health, Guideline for Case MOH, Accra This policy is focused on No empirical evidence is cited Produced through expert
2014 [68] Management of Malaria in providing guidelines for in document preparation views and professional
Ghana malaria case management in knowledge on the
Ghana management of malaria in
Ghana
11 Ministry of Health, National Policy and Guidelines MOH, Ghana Lays down policies and broad Document cites several Through a consultative
2015 [71] for Infection Prevention and guidelines required for the scientific research papers and approach, including several
Control in Health Care Settings practice of a nationally laws of Ghana as well as government and non-
acceptable standard of reports from key international governmental organisations
infection prevention and organisations and individuals
control in healthcare settings
12 Ghana Health Service, National Reproductive Health GHS, Accra Provides explicit directions and No scientific research paper A consultative approach
2014 [72] Service Policy and Standards, focus for streamlining the was cited; however, relevant including government
3rd Edition training and service provision laws in Ghana related to agencies, regulatory bodies,
of reproductive health in abortion and crime were also development partners, NGOs
addition to programmes that cited and other champions working
make reproductive health in the area of reproductive
accessible and affordable health
13 Ghana Health Service, Prevention and Management GHS, Accra Provision of critical guide for Document cite several Prepared jointly, and in
2012 [73] of Unsafe Abortion: the prevention and scientific research papers as different stages, by the GHS/
Comprehensive Abortion Care management of unsafe well as documents from other MOH and several institutions,
and Services Standards & abortion key research organisations individuals and communities
Protocols
14 World Health Organization, Adolescent Job Aid: A Handy WHO It contains guidance on No scientific research evidence Evidence-based approach
2010 [74] Desk Reference Tool for commonly occurring was cited in the document together with extensive
Primary Level Health Workers adolescent-specific or non- consultation and country level
adolescent-specific problems testing for further evidence
or concerns that have not was used in developing the
been addressed in existing document
WHO guidelines, conditions in
adolescents
15 Ministry of Health, Malaria in Pregnancy. Training MOH, Accra Provides strategic guide to No publication was cited Prepared through role play,
2010 [75] for Providers USAID, WHO, GLOBAL health providers for malaria case studies and expert views
FUND treatment in Ghana
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 8 of 29
Table 3 Profile and characteristics of scientific contributions of staff from the Ghana Ministry of Health/Ghana Health Service and related agencies
Authors Author of interest Title of paper Place of work Name of Journal
1. Ganyaglo and Hill, 2012 [76] Gabriel YK Ganyaglo A 6-Year (2004–2009) Review Of Department of Obstetrics and Seminars in Perinatology
Maternal Mortality at the Eastern Gynaecology, Korle Bu Teaching
Regional Hospital, Koforidua, Hospital, Korle-Bu, Accra, Ghana
Ghana
2. Orish et al., 2012 [77] Verner N Orish Adolescent Pregnancy and the Department of Internal Medicine, Acta Tropica
Risk of Plasmodium falciparum Effia-Nkwanta Regional Hospital
Malaria and Anaemia – A Pilot Sekondi-Takoradi, Sekondi, Western
Study from Sekondi-Takoradi Region, Ghana
Metropolis, Ghana
3. Ö Tunçalp et al., 2013 [78] Kwame Adu-Bonsaffoh Assessment of Maternal Near-Miss Department of Obstetrics and International Journal of
and Quality of Care in a Hospital- Gynaecology, Korle-Bu Teaching Gynecology and Obstetrics
Based Study in Accra, Ghana Hospital, Accra, Ghana
4. Abdullah et al., 2011 [79] Francis Abantanga, Assessment of Surgical and Department of Surgery, Korle Bu Journal of Surgical
Elias Sory Obstetrical Care at 10 District Teaching Hospital, Accra, Ghana Research
Hayley Osen Hospitals in Ghana Using On-site Department of Surgery, Komfo
Interviews Anokye Teaching Hospital, Kumasi,
Ghana
Ghana Health Services, Accra,
Ghana
5. Asundep et al., 2013 [80] Cornelius Archer Turpin Determinants of Access to Komfo Anokye Teaching Hospital, Journal of Epidemiology
Antenatal Care and Birth Kumasi, Ghana and Global Health
Outcomes in Kumasi, Ghana
6. Kirkwood et al., 2010 [48] S Amenga-Etego Effect of Vitamin A Kintampo Health Lancet
C Tawiah Supplementation in Women of Research Centre, Ministry of Health,
C Zandoh, Reproductive Age on Maternal Kintampo, Ghana
S Danso Survival in Ghana (ObaapaVitA): A
S Owusu-Agyei, Cluster-Randomised, Placebo-
P Arthur Controlled Trial
7. Dassah et al., 2015 [81] Edward T. Dassah Estimating the Uptake of Maternal Department of Obstetrics and International Journal of
Yaw Adu-Sarkodie Syphilis Screening and Other Gynecology, Komfo Anokye Gynecology and Obstetrics
Antenatal Interventions before Teaching Hospital, Kumasi, Ghana
and after National Rollout of
Syphilis Point-of-Care Testing in
Ghana
8. Rominski et al., 2014 [82] 1. Raymond Aborigo Female Autonomy and Reported Navrongo Health Research Centre, International Journal of
2. Abraham Hodgson Abortion-Seeking in Ghana, West Ghana Health Service, Navrongo, Gynecology and Obstetrics
Africa Ghana
Ghana Health Service, Accra, Ghana
9. Hussein et al., 2005 [83] Mercy Abbey How do Women Identify Health Ghana Health Service, Health Midwifery
Professionals at Birth in Ghana? Research Unit, Accra, Ghana
10. Geynisman et al., 2011 [84] Anthony Ofosu Improving Maternal Mortality Ghana Health Service and Ministry International Journal of
Reporting at the Community of Health, Accra, Ghana Gynecology and Obstetrics
Level with a 4-Question Modified
Reproductive Age Mortality
Survey (RAMOS)
11. Morhe et al., 2012 [85] Emmanuel S.K. Morhe Reproductive Experiences of Department of Obstetrics and International Journal of
Frank K. Ankobea Teenagers in the Ejisu-Juabeng Gynecology, Komfo Anokye Gynecology and Obstetrics
Kwabena A. Danso District of Ghana. Teaching Hospital, Kumasi, Ghana
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 9 of 29
Table 3 Profile and characteristics of scientific contributions of staff from the Ghana Ministry of Health/Ghana Health Service and related agencies (Continued)
Authors Author of interest Title of paper Place of work Name of Journal
12. Okiwelu et al., 2007 [86] Daniel Arhinful Margaret Armar- Safe Motherhood in Ghana: Still Noguchi Memorial Institute for Health Policy
Klemesu on the Agenda? Medical Research, University of
Ghana, Accra, Ghana
13. Witter et al., 2007 [87] Sawudatu Zakariah-Akoto The Experience of Ghana in Researcher, IMMPACT, Noguchi Reproductive Health
Implementing a User Fee Memorial Institute of Medical Matters
Exemption Policy to Provide Research, University of Ghana
Free Delivery Care
14. Subramanian et al., 2010 [88] Nicholas Kanlisi The Ghana Vasectomy Initiative: Ghana R3M Project, Engender Patient Education and Counseling
Facilitating Client–Provider Health, Accra, Ghana
Communication on No-scalpel
Vasectomy
15. Ako and Akweongo, 2009 [89] Matilda Aberese Ako, The Limited Effectiveness of Research Fellow, Navrongo Reproductive Health
Patricia Akweongob Legislation Against Female Health Research Centre, Navrongo, Matters
Genital Mutilation and the Role Upper East Region, Ghana
of Community Beliefs in Upper
East Region, Ghana
16. Moyer et al., 2014 [90] Raymond A. Aborigo ‘They Treat you like you are not Navrongo Health Research Centre, Midwifery
Abraham Hodgson, a Human Being’: Maltreatment Navrongo, Upper East Region,
During Labour and Delivery in Ghana
Rural Northern Ghana
17. Masters et al., 2013 [91] 1. George Amofah Travel Time to Maternity Care Ghana Health Service, Kumasi, Social Science & Medicine
2. Patrick Abaogye and its Effect on Utilization in Ghana
Rural Ghana: A Multilevel Analysis Reproductive and Child Health
Dept., Family Health Division,
Ghana Health Service, Accra,
Ghana
18. Baiden et al., 2006 [92] Baiden F, Unmet Need for Essential 1. Navrongo Health Research Public Health
Amponsa-Achiano K, Oduro Obstetric Services in a Rural Centre, Navrongo, Upper East
AR, Mensah TA, Baiden District in Northern Ghana: Region, Ghana
R, Hodgson A Complications of Unsafe 2. Department of Obstetrics
Abortions Remain a Major Cause and Gynaecology, Kwame Nkrumah
of Mortality University of Science and
Technology, Kumasi, Ghana
3. War Memorial Hospital,
Navrongo, Upper East Region,
Ghana
19. Powell-Jackson et al., 2014 [93] Evelyn K Ansah Who Benefits from Free Research and Development Journal of Development
Healthcare? Evidence from a Division, Ghana Health Service, Economics
Randomized Experiment in Ghana Ghana
20. Sinclair et al., 2013 [94] Martha Gyansa-Lutterodt, Integrating Global and National Ghana National Drugs Programme, PLoS Medicine
Brian Asare, Augustina Koduah Knowledge to Select Medicines Accra, Ghana
for Children: The Ghana National
Drugs Programme
21. Dassah et al., 2015 [95] Edward Tieru Dassah, Factors Associated with Failure Department of Obstetrics and BMC Infectious Diseases
Yaw Adu-Sarkodie to Screen for Syphilis During Gynaecology, Komfo Anokye
Antenatal Care in Ghana: A Teaching Hospital, Kumasi, Ghana
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 10 of 29
Table 3 Profile and characteristics of scientific contributions of staff from the Ghana Ministry of Health/Ghana Health Service and related agencies (Continued)
Authors Author of interest Title of paper Place of work Name of Journal
Case Control Study
22. Cofie et al., 2015 [96] Sodzi Sodzi-Tettey Birth Location Preferences of Project Fives Alive!/Institute for BMC Pregnancy and
Mothers and Fathers in Rural Healthcare Improvement, Childbirth
Ghana: Implications for Pregnancy, Accra, Ghana
Labor and Birth Outcomes
23. Atuahene et al., 2013 [97] David Mensah and Martin A Cross-Sectional Study of National Maternal Health,
Adjuik Determinants of Birth Weight of Malaria Control Programme, Neonatology, and
Neonates in the Greater Accra Accra, Ghana. 3INDEPTH Perinatology
Region of Ghana Network Secretariat, Accra,
Ghana
24. Nakua et al., 2015 [98] Justice Thomas Sevugu Home Birth without Skilled Sekyere-Kumawu Health Pregnancy and Childbirth
Attendants Despite Millennium Directorate, Kumasi, Ghana
Villages Project Intervention in
Ghana: Insight from a Survey of
Women’s Perceptions of Skilled
Obstetric Care
25. Dalaba et al., 2015 [99] Maxwell A Dalaba Cost to Households in Treating Navrongo Health Research Health Services Research
Raymond A Aborigo Maternal Complications in Centre, Navrongo, Ghana
John Williams Northern Ghana: A Cross
Gifty A Aninany Sectional Study
26. Manu et al., 2015 [100] Gloria Quansah Asare, Parent–Child Communication Family Health Division, Ghana Reproductive Health
Kwasi Odoi-Agyarko about Sexual and Reproductive Health Service, Private Mail Bag,
Health: Evidence from the Brong Ministries, Accra, Ghana
Ahafo Region, Ghana RHI Medical Centre, Amanokrom,
Mampong-Akuapem, Eastern
Region, Ghana
27. Achana et al., 2015 [101] Fabian Sebastian Achana, Paul Spatial and Socio-Demographic Navrongo Health Research Centre, Reproductive Health
Welaga, Timothy Awine, Determinants of Contraceptive Navrongo, Upper East Region,
Abraham Oduro, use in the Upper East Region of Ghana
John Koku Awoonor-Williams Ghana Regional Health Directorate,
Ghana Health Service PMB, Upper
East Region, Bolgatanga, Ghana
28. Adjei et al., 2015 [102] 1. Kwame K. Adjei, Martha A. A Comparative Study on the Kintampo Health Research Centre, Reproductive Health
Abdulai, Sam Newton, and Seth Availability of Modern Ghana Health Service, Kintampo,
Owusu-Agyei Contraceptives in Public and Ghana
2. Sam Adjei Private Health Facilities in a Peri- Centre for Health and Social
Urban Community in Ghana Services, Accra, Ghana
29. Amoakoh-Coleman et al., Charles Brown-Davies Completeness and Accuracy of Ghana Health Service, Greater Research Notes
2015 [103] Kerstin Klipstein-Grobusch Data Transfer of Routine Maternal Accra Region, Accra, Ghana
Health Services Data in the Research and Development
Greater Accra Region Division, Ghana Health Service,
Accra, Ghana
30. Hall et al., 2015 [104] Kwabena Danso A Retrospective Analysis of the Ghana Health Service, Sekyere International Journal of
Impact of an Obstetrician on Kumawu District Health Gynecology and Obstetrics
Delivery and Care Outcomes at Directorate, Kumawu, Ghana
Four District Hospitals in Ghana
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 11 of 29
Table 3 Profile and characteristics of scientific contributions of staff from the Ghana Ministry of Health/Ghana Health Service and related agencies (Continued)
Authors Author of interest Title of paper Place of work Name of Journal
31. Bawah et al., 2009 [105] Ayaga Bawah The Impact of Immunization on The INDEPTH Network Scandinavian Journal of
the Association between Poverty Public Health
and Child Survival: Evidence from
Kassena-Nankana District of
Northern Ghana
32. Adongo et al., 1997 [106] Adongo B. Philip Cutural Factor Constraining the Navrongo Health Research Centre, Social Science & Medicine
Introduction of Family Planning Ministry of Health, Navrongo,
among the Kassena-Nankana Ghana
District of Northern Ghana
33. Amoakohene, 2004 [107] Amoakohene Violence against Women in Ghana Health Service Social Science & Medicine
Ghana: A Look at Women’s
Perceptions and Review of Policy
and Social Responses
34. Witter et al., 2009 [108] Margaret Armar-Klemesu Providing Free Maternal Health Noguchi Memorial Institute for Ghana Global Health
Care: Medical Research, Accra, Ghana Action
Ten Lessons from an Evaluation
of the National Delivery
Exemption Policy in Ghana
35. Oppong et al., 2015 [109] Samuel A. Oppong, Michael Y. Gestational Diabetes Mellitus Ghana Health Service, Accra, International Journal of
Ntumy, Mary Amoakoh-Coleman, among Women Attending Ghana Gynecology and Obstetrics
Deda Ogum-Alangea, Emefa Prenatal Care at Korle-Bu
Modey-Amoah Teaching Hospital, Accra, Ghana
36. Obrist et al., 2014 [110] Ernest Osei-Bonsu, Baffour Factors Related to Incomplete Komfo Anokye Teaching Hospital, Breast
Awuah Treatment of Breast Cancer in Department of Medical Oncology
Kumasi, Ghana and Radiation, & Central
Administration, Kumasi, Ghana
37. Shelus et al., 2015 [111] Stephen Mensah, Lessons from a Geospatial Global Health Population and International Journal of
Kafui Dzasi Analysis of Depot Nutrition, Accra, Ghana Gynecology and Obstetrics
Medroxyprogesterone Acetate
Sales by Licensed Chemical Sellers
in Ghana
38. Sukums et al., 2015 [112] Nathan Mensah, Promising Adoption of an Navrongo Health Research Centre, International Journal of
Afua Williams Electronic Clinical Decision Navrongo, Ghana Medical Informatics
Support System for Antenatal
and Intrapartum Care in Rural
Primary Healthcare Facilities in
Sub-Saharan Africa: The
QUALMAT Experience
39. Aborigo et al., 2015 [113] Akawire Aborigo The Traditional Healer in Obstetric Navrongo Health Research Centre, Social Science & Medicine
Care: A Persistent Wasted Navrongo, Ghana
Opportunity in Maternal Health
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 12 of 29
Table 4 Profile and characteristics of available evidence outside of Ghana Ministry of Health/Ghana Health Service that can be used to inform reproductive and child health
policy in Ghana
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
PAPERS ON MATERNAL HEALTH
1. de Souza, 2009 [114] Evaluation of evidence-based Inclusion of geographic information GIS health applications in Ghana are A strong collaboration between
approaches to decision- systems (GIS) as part of Ghana’s few, with little or perhaps no effects academics in the area of GIS and
making health information systems on policy and decision-making health professionals in the Ghana
Including GIS as part of Health Health Service will be key to
Information Systems can go a long advancing health-based GIS
way in promoting the generation
and use of evidence for decision-
making, programme development,
resource allocation and surveillance
systems
2. Awusabo-Asare et al., 2004 [115] Research evidence on A synthesis of research evidence on Evidence suggest a sizeable gap Notwithstanding that young people
adolescent sexual and adolescent sexual and reproductive between the age at first sex and the are aware of the existence of
reproductive health health age at first marriage; generally, first different contraceptive methods,
sexual intercourse happens about including male condoms, usage
2 years before first marriage for remains relatively low, with access to
young women, with young men health information and services for
taking place about 5 years before young people being uneven
first marriage
3. Croce-Galis, 2004 [116] Evidence on sexual and Documents what is known about There is a lack of information about Additional evidence is required to
reproductive health Ghanaian adolescents’ sexual and the implementation, monitoring and, explain the gap between awareness
reproductive health behaviours and most importantly, the evaluation of of sexual and reproductive health
needs, with particular emphasis on interventions aimed at improving services and actual use of such
HIV/AIDS the sexual and reproductive health services as well as information about
of Ghanaian youth the implementation, monitoring and,
most importantly, the evaluation of
interventions aimed at improving
the sexual and reproductive health
4. Baker et al., 2012 [117] Promotion of maternal Understanding how to increase The study suggests very little There is need to prioritise the format
healthcare intervention, which clinical practice guideline potential variance between national guidelines of guidelines to increase their
is already operational to improve quality of care for for maternal health and WHO usability and applicability and to
mothers in three sub-Saharan African recommendations; this is not consider these attributes together
countries including Ghana withstanding the that use of clinical with implementation as integral to
practice guidelines in practice was their development processes; the
perceived to be limited prioritisation of the format of
guidelines will improve applicability
and usability
5. Mayhew, 2000 [118] Evaluation of a range of Integrating STI services in family The paper suggests that a ‘blanket’ Enhancing, at district level, the voice
policies developed for sexually planning (FP)/maternal and child policy to integrate STI and FP/MCH of nurses working at the community
transmitted infection (STI) health (MCH) services services may be inappropriate in level and promoting collaborative,
management particular contexts; the culturally specific and community-
implementation of health policies is based initiatives could facilitate ad-
influenced, and often impeded not dressing the issues
only by local service contexts,
economic and epidemiological
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 13 of 29
Table 4 Profile and characteristics of available evidence outside of Ghana Ministry of Health/Ghana Health Service that can be used to inform reproductive and child health
policy in Ghana (Continued)
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
factors, but also by culturally defined
social attitudes and behaviours
6. Ganyaglo and Hill, 2012 [76] Review of issues on maternal A 6-year review of maternal mortality The study revealed that the highest Referral of patients to hospital on a
mortality number of deaths was recorded in timely basis could be important for
the period following termination of reducing preventable maternal
pregnancy (abortion or delivery) deaths
7. Darteh et al., 2014 [119] Decision-making in Examination of factors that influence Women who were in the richest, rich Interventions and policies aimed at
reproductive health (RH). the decision to engaging in sexual and middle wealth index quintiles empowering women to take control
intercourse and condom use among were more likely to make decisions of their reproductive health should
women to engage in sexual intercourse as target women from less wealthy
well as use condoms compared to backgrounds and those with low
the poorest; additionally, women educational attainments
with some level of education were
more likely to make decisions on
sexual intercourse than those with
no formal education
8. Sundaram et al., 2014 [120] Evaluation of MHC Examination of whether the R3M Associations between provider The R3M programme is important
intervention already in programme made a difference to attitudes and knowledge of the law for safe abortion provision; increased
operation the provision of safe abortion on both outcomes were either non- provider confidence is crucial to
services and post abortion care; significant or inconsistent, including improving both safe abortion
also examine the role played by for providers with clinical knowledge provision and post-abortion care
provider attitudes and knowledge of of abortion provision; provider confi-
the abortion law, and on providers dence however is strongly associated
with clinical training in service with service provision
provision
9. Reichenbach, 2002 [121] Evaluation of the politics of Examines the influence of political Traditional priority-setting methods The policy priority measure provides
priority-setting in RH and organisational factors on cannot explain the priority given to a more complete picture of
national priority-setting for repro- breast cancer in Ghana; it demon- reproductive health priorities and is
ductive health strates how local politics can trump useful for better understanding of
scientific and economic evidence the implications of the priority-
and suggests that the priority-setting setting process for reproductive
process can have unforeseen equity health
and social implications
10. Amoako et al., 2015 [122] Evaluation of MHC Investigated the impact of maternity- The rich–poor gap in skilled birth The maternal care fee exemption
intervention already in related fee payment policies on the care use was highly pronounced policies specifically targeted towards
operation uptake of skilled birth care amongst during the ‘cash and carry’ and ‘free the poorest women had limited
the poor in Ghana antenatal care’ policies period; the impact on the uptake of skilled birth
benefits during the ‘free delivery care
care’ and ‘NHIS’ policy periods
accrued more for the rich than the
poor
11. Twum-Danso et al., 2014 [123] Evaluated MHC intervention Test the feasibility and effectiveness There is a slower increase in skilled The study provides a model for
already in operational of the new early post-natal care delivery over a longer period of time; improving the implementation of
(PNC) policy and its subsequent the early PNC policy was scaled up other national health policies to
scale-up throughout northern Ghana over the subsequent 2 years to 576 accelerate the achievement of the
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 14 of 29
Table 4 Profile and characteristics of available evidence outside of Ghana Ministry of Health/Ghana Health Service that can be used to inform reproductive and child health
policy in Ghana (Continued)
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
health facilities in all 38 districts of Millennium Development Goals in
northern Ghana Ghana and other resource-poor
countries
PAPERS ON CHILD HEALTH
1 Friedman et al., 2015 [124] Evaluated child healthcare Using SMS from licensed chemical Using SMS intervention, providers Actual practices vary considerably
(CH) intervention already in sellers in Ghana to recommend the self-reported practices improved but from reported practices
operation use of oral rehydration salts and zinc not their actual practices
for the management of childhood
diarrhoea
2 Tawiah-Agyemang et al., Evaluated a CH intervention Probed the reason why women in Facilitating factors that aided for Raising awareness on early initiation
2008 [125] already operational Ghana initiate breast-feeding early or early inception included delivery in a of breastfeeding in the communities
late, who advices on initiation and health facility, where the staff and the policy arena is crucial with
what foods or fluids are given to ba- encouraged early breast-feeding, and interventions focusing on finding
bies when breast-feeding initiation is the belief in some ethnic groups that solutions to barriers to early initiation
late putting the baby to the breast en- with a community component
courages the flow of milk
3 Edmond et al., 2007 [126] Evaluated a CH intervention Looked at early infant feeding No clear associations were seen This study gives the first
already operational practices and its effect on infection- between these feeding practices and epidemiologic proof of a causal
specific neonatal mortality in breast- non-infection-specific mortality; pre- association between early
fed neonates aged 2–28 days lacteal feeding was not associated breastfeeding and reduced infection-
with infection or non-infection- specific neonatal mortality in young
specific mortality human infants
4 Manu et al., 2014 [127] Evaluated a CH intervention Evaluation of community volunteer In resource-constrained settings, Isolated community interventions
already implemented assessment and referral community volunteers can be suc- will have limited impact unless
implemented within the Ghana cessfully used to identify through as- coupled with concurrent
Newhints home visits cluster- sessment and referral of sick improvement of quality within
randomised controlled trial newborns to health facilities as rec- health facilities
ommended in the WHO/UNICEF
joint statement on home visits in
2009
5 Adongo et al., 2005 [128] Use of health knowledge in Explored how local community People recognise the term ‘malaria’ Simply informing communities that
policy knowledge about malaria acts as a but have limited biomedical mosquitoes cause malaria does not
barrier to the use of insecticide- knowledge of the disease, including appeal to people; health education
treated nets in three settings its aetiology, the role of the vector, needs to move beyond that and
and host response; convulsions and inform people why it is the
anaemia are rarely linked to malaria mosquito that causes malaria and
not other insects
6 Nyarko et al., 2001 [129] Immunisation status and child Examine the influence of Children who have received no There is the need for further research
survival immunisation coverage on all-cause immunisations are at substantially on the all-cause mortality impact as-
child mortality in Kassena-Nankana higher risk of death through sociated with these vaccines in de-
District of northern Ghana approximately the first year of life veloping countries
than those who have some
vaccination coverage, whether
complete or incomplete
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 15 of 29
Table 4 Profile and characteristics of available evidence outside of Ghana Ministry of Health/Ghana Health Service that can be used to inform reproductive and child health
policy in Ghana (Continued)
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
7 Singh et al., 2013 [130] Impact evaluation of MCH Evaluate the influence of the early There was an association between The quality improvement approach
intervention already phase of Project Fives Alive!, a the early pregnancy identification of testing and implementing simple
operational national child survival improvement change category with increased and low cost locally inspired
project, on key maternal and child skilled delivery; also, a greater changes has the potential to lead to
health outcomes number of change categories tested improved health outcomes at scale
was associated with increased skilled both in Ghana and other low- and
delivery middle-income countries
8 Vance et al., 2014 [131] Implemented a RH Determined whether integrating FP Reported referrals to FP services did Rigorous evidence of the success of
intervention to improve CH messages and referrals into facility- not improve nor did women’s integrated immunisation services in
based, child immunisation services knowledge of factors related to resource-poor settings remains weak
increase contraceptive uptake in the return of fecundity
9- to 12-month post-partum period
9 Lei et al., 2006 [132] Implemented an intervention Assessed the effect of a millet drink No effects of the intervention were A preventing effect of KSW on
in CH (KSW), spontaneously fermented by found with respect to stool antibiotic-associated diarrhoea which
lactic acid bacteria, as a therapeutic frequency, stool consistency and could help reduce persistent
agent among Ghanaian children duration of diarrhoea; but KSW was diarrhoea
with diarrhoea associated with greater reported
well-being 14 days after the start of
the intervention
PAPERS ON NEONATAL HEALTH
1. Chandramohan et al., Implemented an intervention The effects of intermittent preventive Intermittent preventive treatment for There is concern about the
2005 [133] in CH treatment for malaria in infants with malaria with sulfadoxine- possibility of a rebound in the
sulfadoxine-pyrimethamine in an pyrimethamine proved effective in incidence of malaria in the second
area of intense, seasonal reducing malaria and anaemia in year of life despite its effectiveness in
transmission infants the previous year
2. Edmond et al., 2008 [134] Evaluated CH intervention, Diagnostic accuracy of a verbal The VA performance for stillbirth Further modifications are needed in
which is already operational autopsy (VA) tool in ascertaining the diagnoses is poor; accuracy was the use of WHO VA in routine child
causes of stillbirths and neonatal higher for intrapartum obstetric health programmes; there is also the
deaths complications and antepartum need to access the diagnostic
maternal disease. For neonatal accuracy of the VA tool in other
deaths, sensitivity was > 60% for all regions and in multicentre studies
major causes
Overall, VA diagnostic accuracy was
higher than expected.
4. Bryce et al., 2010 [135] Evaluated a CH intervention Analysed how the Lives Saved Tool Compared to 2006 levels, under-5 The feasibility and usefulness of LiST
already operational (LiST) was used as part of an early mortality could be reduced by at as part of the programme planning
assessment of the expected impact least 20% by 2011 by achieving na- process at the community levels
of MCH intervention plans tional coverage targets for just four requires further experience
or five high-impact interventions
5. Oduro et al., 2012 [136] Health and demographic The activities and potential of the Using the NHDSS data, the NHDSS has been designed to
surveillance system profile NHDSS for collaborative research are attainment of the child survival provide an efficient platform for
described Millennium Development Goals has evaluating health and social
been rapid with huge decline in interventions
maternal mortality ratio and the
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 16 of 29
Table 4 Profile and characteristics of available evidence outside of Ghana Ministry of Health/Ghana Health Service that can be used to inform reproductive and child health
policy in Ghana (Continued)
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
impact of immunisation on the
relationship between poverty and
child survival in the operational area
6. Hulton et al., 2014 [137] Use of evidence in MCH policy Introduces the Evidence for Action There were inadequacies in using Given that this approach is effective
(E4A) programme, the rationale and data for decision-making and in pol- in dealing with the deficiencies
its effectiveness in initial findings itical will for MNH for all E4A coun- responsible for poor quality of care,
across six E4A countries tries; gaps in data access and then others can build on this to
information were key drawbacks to make future investment in MNH
decision-making in all six countries more cost-effective
7. Hill et al., 2008 [138] Use of knowledge in CH Described how an integrated home Identified community entry activities Formative research is an important
intervention visit intervention for newborns in in mobilising community support for stage in helping to ensure the
Ghana was designed the intervention, to encourage self- development of an effective,
identification of pregnant and deliv- appropriate and sustainable
ered women and to motivate the intervention
volunteer through community
recognition
8. Moyer et al., 2013 [139] Analysed an MCH intervention Determined the types of access to Affordability was the strongest Even among women with health
already in practice care most strongly associated with determinant linked to delivery insurance, affordability remains an
facility-based delivery among location; social access variables, important determinant of facility
women including needing permission to delivery; however, affordability was
seek healthcare and not being an important determinant of facility
involved in decisions regarding delivery in Ghana, even among
healthcare contributed in reducing women with health insurance, but
the possibility of facility-based deliv- social access variables had a
ery when examined individually mediating role
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 17 of 29
Table 5 Profile and characteristics of papers on scaling up of reproductive and child health interventions in Ghana
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
1. Kapungu et al., 2013 [140] Evaluation of phase 1 of a Operations research study, designed Overall, 96% of deliveries resulted in The initial work carried out in Phase 1
maternal and child health (MCH) to reduce postpartum haemorrhage- healthy outcomes for the mother, of the study is vital in guiding
intervention already operational related morbidity and mortality with only 4.0% of births having misoprostol distribution in Phase 2
complications although challenges exist
2. Witter et al., 2009 [108] Evaluates maternal healthcare National delivery exemption policy Delivery exemptions can be effective Appropriate and effective
(MHC) intervention already for free MHC and cost-effective, and despite being implementation of the free MHC policy
operational universal in application, it can benefit is key if it is expected to result in
the poor; however, there is the need reduced mortality for mothers and
for adequate funding and strong in- babies
stitutional ownership
3. Twum-Danso et al., 2014 [123] Evaluated MHC intervention Test the feasibility and effectiveness There is a slower increase in skilled The study provides a model for
already in operational of the new early post-natal care delivery over a longer period of time; improving the implementation of other
(PNC) policy and its subsequent the early PNC policy was scaled up national health policies to accelerate
scale-up throughout northern Ghana over the subsequent 2 years to 576 the achievement of the Millennium
health facilities in all 38 districts of Development Goals in Ghana and other
northern Ghana resource-poor countries
4. Singh et al., 2013 [130] Impact evaluation of MCH Evaluate the influence of the early There was an association between The quality improvement approach of
intervention already operational phase of Project Fives Alive!, a the early pregnancy identification testing and implementing simple and
national child survival improvement change categories with increased low cost locally inspired changes has
project, on key MCH outcomes skilled delivery; additionally, a greater the potential to lead to improved
number of change categories tested health outcomes at scale both in Ghana
was associated with increased skilled and other low- and middle-income
delivery countries
5 de Savigny et al., 2012 [141] Adoption of innovation in the Evaluated the introduction of Investment in long-term, managed Contextual requirements for the success
health system vouchers for malaria prevention in stakeholder engagement throughout of an intervention should be considered
Ghana and Tanzania the design and implementation before an intervention is picked from
stages of new complex health inter- one context and piloted in another
ventions appears to be critical for
ownership and sustained integration
of the intervention in the system
6. Philips et al., 2007 [142] Evaluation of a scaled-up Used research to guide the The process concluded with Large-scale health systems
intervention development and scaling up of research-guided programme expan- development was achieved
community-based health and family sion, with each stage associated with
planning programmes shifts in generations of questions,
mechanisms and outcomes as the
process unfolded
7. Awoonor-Williams et al., Evidence-based innovation and Bridging the gap between evidence- The favourable effect of the The results confirm the need for
2004 [143] health-sector reform gap based innovation and national community-based health planning strategies to bridge the gap between
health-sector reform and services intervention on family Navrongo evidence-based innovation
planning and safe-motherhood indi- and national health-sector reform
cators is suggestive that innovations
such as the Navrongo experiment is
transferable to impoverished rural
settings elsewhere
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 18 of 29
Table 5 Profile and characteristics of papers on scaling up of reproductive and child health interventions in Ghana (Continued)
S/No Author/year of publication/ Category of intervention Health issue of intervention Evidence generated Policy-relevant conclusion
reference
8. Awoonor-Williams et al., Evaluated the impact of a MCH Described the Ghana Essential Health GEHIP improves the Community GEHIP is expected to contribute to
2013 [144] intervention Intervention Project (GEHIP), a Health Planning and Services model national health policy, planning and
plausibility trial of strategies for in various ways resource allocation that will be needed
strengthening Community Health to accelerate progress with the
Planning and Services, especially in Millennium Development Goals
the areas of maternal and newborn
health
9. Hill et al., 2010 [145] Evaluated CH intervention collected data on thermal care Respondents knew that keeping the Thermal care is a key component of
practices in rural Ghana to inform baby warm was essential for health, community newborn interventions, the
the design of a community newborn but 71% of babies born at home design of which should be based on an
intervention had delayed drying, 79% delayed understanding of current behaviours
wrapping, 93% early bathing and and beliefs
10% were placed skin-to-skin
10. Awoonor-Williams et al., Lessons learnt from a scaled-up Strengthening of health systems That community-based care could Key scaling-up lessons: (1) place nurses
2013 [146] intervention related to maternal health reduce childhood mortality by half in in home districts but not home villages,
only 3 years (2) adapt uniquely to each district, (3)
mobilise local resources, (4) develop a
shared project vision, and (5) conduct
‘exchanges’ so that staff who are initiat-
ing operations can observe the model
working in another setting, pilot the ap-
proach locally and expand based on les-
sons learned
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 19 of 29
the MOH and related agencies, local and international identifies research needs of units and directorates and
NGOs in the health sector, donors and academia) and channels them to researchers either within the health
working in RCH for comments. The comments provided sector or outside of it.
were used to amend the draft report. In addition to the This notwithstanding, a few units collate their research
comments, a questionnaire was administered to partici- needs and incorporate this information into their annual
pants of the stakeholder meeting, to captured respond- plans to be performed when funds are available either
ent data in relation to official designation attributes; through Government of Ghana budget or from donor
knowledge and application of information communica- funds. Within the RCH unit of the GHS, for example,
tion technology; knowledge of the policy-making the practice has been to aggregate research needs and
process; capacity to use evidence; knowledge of policy incorporate these as part of the programme of work for
and policy-making processes related to MNCH; acquisi- the year, with the actual research carried out when funds
tion of research evidence relevant to MNCH; assessment become available either through the Government of
of the validity, quality and application of research evi- Ghana budget or donor-funded programmes. Besides the
dence relevant to MNCH; ability to adapt formats of re- above, there are also mechanisms that make it possible
search results to provide information useful to for research needs of the sector to be communicated to
decision-makers in MNCH; and application of evidence donors so that funds are made available to undertake
in decision-making relevant to MNCH. such research or incorporated into the objectives of
A total of 15 participants (GHS n = 7, MOH n = 1, existing research funded by donors.
NGOs n = 4, Donors and Academia n = 4) responded to The mixed picture given by respondents interviewed
the questionnaire. Besides the questionnaire, we solicited and participants of the group discussion seems to be
and incorporated the views of the 36 participants on confirmed by the answers to the questions exploring the
what they believe promotes the use of evidence in their (1) existence of a forum or process to coordinate the set-
workplace through group discussions. Specifically, ting of health research priorities or the (2) alignment of
participants deliberated on issues related to aptitudes, performance incentives to activities encouraging use of
skills, institutional environment, platforms/mechanisms, research evidence, in the survey carried out during the
sources of evidence, nature of evidence, opportunity for stakeholder meeting in Accra. The results suggest that
the use of evidence and support needed to use evidence 71.43% of respondents of the first question agree to the
for policy formulation. Although participants in the existence of a forum/process used to coordinate the set-
group discussion and respondents to the questionnaire ting up of research priorities in the health sector. On the
were in the stakeholder meeting as representatives of contrary, the results of the second question suggest that
their respective organisations, their participation was approximately 60% of respondents believe that their man-
based on their consent and not on compulsion. Data agement’s participation in fora that discusses research evi-
from the questionnaire and group discussions was dence related to organisational goals is inadequate.
analysed and reflected in the draft report. It is im- However, it is important to emphasise that the lack of
portant to emphasise that data collected was analysed a structured institutional mechanism within the health
and presented along the themes/components of know- sector to identify research needs and communicate these
ledge transfer and research utilisation framework pre- to researchers does not in any way mean that
sented in Fig. 1. policy-makers are not interested in the use of research
evidence to inform policy-making. However, the findings
Results suggest that the challenge is rather the lack of local
In this section, we present the findings of the study funds to carry out research. The findings further suggest
structured around the components of the knowledge that a greater proportion of research in Ghana’s health
transfer and research utilisation framework. sector is funded by donors, whose objectives may not al-
ways coincide with the goals of domestic policy-makers.
Problem identification and communication Thus, policy-makers are less likely to plan for their re-
In agreement with the core issues identified under this search needs given that they are less likely to receive
component, we sought to elucidate, from the data col- funds domestically to carry out the research.
lected, the procedure used to identify RCH research
needs and how those needs were communicated to re- Knowledge/research development and selection
searchers. Discussions with key managers within the Production, synthesis and adaptation of knowledge
health sector, as well as informal networks of individuals In line with the conceptual framework, this section pre-
who have once worked in policy positions in the health sents evidence that can be reasonably used to examine
sector, suggest that there is currently no institutional the capacity of the health sector to generate, synthesise
structure either at the level of the MOH or GHS that and adapt RCH evidence to inform RCH policy.
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 20 of 29
Information provided on the website of the GHS, in research, either synthesised or in raw form, that could
addition to discussions with key managers within the potentially and readily be used in the formulation of RCH
GHS, suggest that there are currently formal structures policy was also examined. Overall, 28 scientific
in place to ensure a coherent approach to evidence gath- peer-reviewed publications were examined (Table 4), in-
ering and synthesis. The GHS has a Research and Devel- cluding 11 on maternal health, 9 on child health and 8 on
opment Division headed by a director. The division has neonatal health. Out of the 28 papers, 2 were systematic
three research centres (NHRC, KHRC and DHRC), in reviews of the existing literature, 3 on use of evidence in
addition to three other departments responsible for (1) policy-making and 23 on the evaluation of interventions
documentation, dissemination and advocacy, (2) ethics already in operation. This is indicative of the existence of
and research management and (3) research. As captured extensive evidence on RCH produced outside of the GHS
on the GHS website, “the key mandate of the RDD [Re- but available to policy-makers within the GHS.
search and Development Division] is to generate infor- The output of the research centres is also augmented
mation through relevant research to strengthen decision by a strong health information management system,
making, set health priorities, efficient resource allocation, which collects, processes and stores data from different
and inform health interventions planning and implemen- clinical and non-clinical institutions within the GHS.
tation in order to deliver better health services to im- Discussions with actors within and outside of the GHS
prove health status of the Ghanaian population” [42]. indicate that the output of the health information man-
To confirm that the information above, as captured on agement system constitutes strategic evidence (inputs)
the GHS website, is operational, a review of the websites into different policies, including RCH. The health infor-
of the three research centres was performed. The results mation management system is equally augmented by
from the review suggest extremely impressive activity in data from several demographic surveillance systems, in
terms of completed projects, on-going projects and new addition to data from nationally representative surveys
projects funded by internationally reputable funding or- such as the GDHS and the Ghana Living Standards
ganisations such as WHO, International Labour Organ- Survey, conducted every 5 years. Mostly, data from the
isation (ILO), Bill and Melinda Gates Foundation, three sources mentioned above are processed and
Rockefeller Foundation, Pfizer Corporation, Volkswagen presented in a format that can easily be used by
Foundation, National Institute of Health, World Bank, policy-makers.
West African Health Organization (WAHO), and other Clearly, the sources above point to the fact that the
bilateral and multilateral donors. In addition to these health sector in Ghana has enormous capacity both at
projects, the three centres have impressive outputs in the individual and organisational level to produce the
the form of peer-reviewed scientific publications from much-needed evidence for policy formulation. This view
completed projects. is equally supported by results of responses to the ques-
For example, the information on the website of the tionnaire administered to participants of the Accra
DHRC showed 6 completed projects, 3 on-going projects stakeholder meeting. The majority of respondents (as
and 29 peer-reviewed scientific publications [43]. In per their answers to different questions regarding the
Dodowa, 4 out of a total of 9 projects and 5 out of a total capacity of individuals within the GHS and the GHS as
of 29 scientific publications were on RCH. The NHRC, on an institution to perform good quality research) believe
the other hand, had 9 new projects, 16 on-going projects, that the GHS and its staff have adequate capacity to pro-
51 completed projects and 164 peer-reviewed scientific duce good quality evidence to aid policy-making.
publications [44]. Out of a total of 73 projects in Nav-
rongo, 17 were on RCH, with 29 out of a total of 164 sci- Characteristics of knowledge to be transferred
entific publications being on RCH. The KHRC had 31 This sub-section examines issues related to (1) the rela-
completed projects and 6 on-going projects [45]. Most im- tive advantage and complexity of the knowledge to be
portantly, issues on MNCH featured strongly in the pro- transferred, (2) the compatibility of the knowledge to be
jects executed and scientific publications arising from the transferred with existing beliefs and organisational
work of all the three research centres. norms, and (3) how the knowledge to be transferred is
Besides the work of the research centres, the capacity of aligned to the needs of policy-makers.
actors within GHS (staff and their collaborators) to pro- Most of the research outputs found on the websites of
duce good quality scientific evidence on MNCH was also the three research institutions are in the form of
examined. The results (Table 3) suggest that personnel at peer-reviewed research papers instead of alternative forms,
different levels of the GHS hierarchy are actively involved such as policy briefs, that can be easily used by
(i.e. either solely or in collaboration with others) in the policy-makers. Although respondents to the questionnaire
production of scientific research evidence on RCH. In suggest that knowledge of policy briefs and how to use
addition, evidence that suggests the availability of RCH them is widespread in Ghana’s health sector, the evidence
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 21 of 29
from the study suggests that RCH-related researchers in developed to ensure that actions at lower levels are con-
Ghana hardly use such means to disseminate their findings. sistent with the policies, protocols and conventions sub-
Although some respondents during the group discus- scribed to. In addition, the evidence-based nature of
sion argued that, generally, public institutions in Ghana work in the health sector makes it an environment that
do not have the culture of evidence-based policy-making, generally has few barriers to the use of research evidence
this was not seen to be the case in the health sector. The for policy-making. This notwithstanding, major con-
difference may be due to the fact that the health sector straints to the use of evidence in policy include (1) how
has relatively better qualified staff who are also more ex- to ensure that research in general, and for that matter
perienced in research compared to other sectors in Ghana. health-related research, gets the right attention at the
Thus, the use of research evidence in policy-making may highest level of political and administrative leadership so
not be foreign to such actors. This assertion is equally as to attract the right level of funding, and (2) the lack of
confirmed by the results from the questionnaire. However, robust and comprehensive institutional structures that
what may constitute a challenge is the extent to which the ensure that the numerous health sector-related research
available evidence is aligned to the needs of being performed (i.e. whether specifically related to RCH
policy-makers. As earlier on indicated, and as confirmed or other relevant health issues) is aligned to the needs of
by the results of the questionnaire, a larger proportion of policy-makers. The current disconnect between know-
research in the health sector in general, and on RCH in ledge production activities and the needs of policy-makers
particular, are mostly funded by donors who often have eventually affects the extent to which policy-makers make
their own objectives, which may be different from those of use available knowledge to inform policy formulation.
policy-makers. Thus, besides a few circumstances where This position is confirmed by the results of the survey
users of evidence collaborate with donors to conduct re- (questionnaire) where respondents suggest that institu-
search, evidence produced from on-going research may tional level incentives for (1) carrying out research, (2) use
not be aligned to the evidence/knowledge needs of of research evidence implementation committees, (3)
policy-makers. This therefore constraints on-going efforts capacity to present research evidence in concise and
to improve the use of evidence to inform policy. accessible languages, and (4) capacity to synthesise differ-
ent research evidence that addresses a common problem
Analysis of context into a single document that could be attractive to
This section deals with identified barriers and incentives policy-makers are inadequate, albeit that the required cap-
to knowledge transfer at the individual, organisational acity and willingness to carry out good quality research
and environment level. As is evident in the research out- exist at the individual level.
put of the three research centres and the large presence
of GHS staff in the RCH literature, the capacity of indi- Knowledge transfer activities or interventions
viduals within the health sector to produce, synthesise This aspect of the knowledge transfer and utilisation
and potentially use research evidence in the formulation framework looks at actual interventions put in place to
of RCH policies cannot be in doubt. In addition, the facilitate/ensure the transfer of knowledge/evidence for
multiplicity of professionals (medical doctors, nurses, al- the purposes of policy-making. In the context of Ghana’s
lied health professionals, academics, etc.) within the health sector, the most common intervention is post
health sector creates internal competition with respect research dissemination workshops/conferences. In few
to knowledge production and synthesis at the individual instances, targeted policy briefs from completed research
level. It is important though to caution that the capacity are disseminated to key stakeholders. However, as
to produce and use evidence at the individual level may already indicated based on evidence from the three
not in itself translate into the actual use of evidence in research centres, the use of policy briefs as a tool for en-
policy formulation. suring the uptake of research evidence into policy in
Besides the individual level capacity, the findings of general and RCH in particular is rather scarce. The
the study also suggest that there are several institutional evidence gathered also suggests that advocacy by re-
and environmental incentives that promote the use of searchers as well as dialogue between donors and
evidence in policy formulation within Ghana’s health policy-makers constitute some of the channels via which
sector. These include the sector-wide performance as- research evidence on some key policy issues are dis-
sessment framework linked to a set of internationally cussed and consensus is reached on the possibility of
acceptable indicators that are also evidence-based, the adopting such evidence to aid policy formulation.
subscription of the government through the MOH to
major health-related international policies and conven- Knowledge/research utilisation
tions that are based on research evidence. This is This component of the knowledge transfer process looks
evidenced by the several guidelines and protocols at the actual use of available evidence in the formulation
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 22 of 29
of policies. Following from the evidence gathered, we ex- positive effect on pregnant women [48]. Again, it is on
amined the level and extent to which the extensive evi- record that the Emergency Obstetric, Maternal and New
dence available, both within and outside of the GHS, is Born Care study in Ghana [49] informed GHS’ adoption
used in the formulation of policies and guidelines. Thus, of the maternal acceleration fund policy to facilitate
8 policy documents (6 on maternal health, 1 on child MNCH in 2011. Additionally, evidence from the EM-
health and 1 on newborn health; Table 1) were accessed BRACE study is currently being used by the GHS to
and reviewed with the aim of identifying whether the adopt a special maternal card to help track the progress
contents were informed by existing scientific evidence. of pregnant women so that they can adhere to their con-
The findings indicated that 3 out of the 8 policy docu- tinuum of care [50]. Information from the DHRC also
ments reviewed used an evidence-based approach (i.e. suggests the use of research evidence to support health
either through citation of scientific research publica- policy. For example, project briefs from the DHRC show
tions, synthesis of research evidence from the academic policy impact in terms of level of policy-making, type of
literature or adaptation of benchmarks from key stake- policy, nature of policy impact, policy networks, political
holder organisations such as WHO) in developing the capital and inclusion in policy documents.
document. In addition to the policies, 15 standard proto- From the above, one can argue that, although a struc-
cols and practice guidelines (Table 2) covering maternal tured and robust organisational mechanism to ensure
and adolescent health (n = 11), neonatal and child health the use of scientific research evidence to inform policy
(n = 1), general infection prevention and control (n = 1) formulation does not exist, actors within the health
and malaria prevention (n = 2) were also reviewed. Out sector are relying on existing, albeit weak, institutional
of the 15 protocols and practice guidelines, 5 were platforms to transfer knowledge gained from research to
evidence informed. Surprisingly, however, the policy policy and practice.
documents and practice guidelines that suggested the
use of scientific evidence did not explain the evidence Discussion
generation processes and how the evidence was used in The information extracted in this study is herein used to
the policy/practice guidelines. Nevertheless, it is clear answer the key question of whether Ghana’s health sec-
that the 8 policy documents and 15 protocols and prac- tor has institutional structures or mechanisms in place
tice guidelines were all developed through a consultative for the production and use of evidence to inform policy
and participatory approach mostly involving stake- formulation in general and RCH policies in particular.
holders and professionals knowledgeable in the subject The findings above suggest that there are currently
area. It is also important to state that discussions with organisational-wide structures in place for the produc-
key managers within the RCH division of the GHS indi- tion of RCH evidence. This is based on the fact that the
cated that almost all the standard protocols and practice GHS has a well-functioning and extremely active re-
guidelines in use are adaptations from regulators or key search and development division, as is evident in the
global institutions (WHO, UNICEF, UNFPA World number of projects and peer-reviewed scientific research
Bank, etc.), which are known to rely on scientific evi- publications completed. The fact that most of the
dence in the production of such guidelines. research projects carried out by the research centres are
In addition to the review of the policies and practice funded by internationally reputable funding organisa-
guidelines, another channel through which knowledge tions such WHO, ILO, Bill and Melinda Gates Founda-
translation may occur (i.e. scaling up of interventions tion, Rockefeller Foundation, Pfizer Corporation,
based on evidence from a pilot phase) [46, 47] was also Volkswagen Foundation, National Institute of Health,
examined. The results show (Table 5) that 10 important World Bank, WAHO, and other bilateral and multilat-
interventions were scaled-up based on evidence from eral donors, speaks to the quality of their research
the pilot/experiment phase. A key intervention in this output. It is important to emphasise that quality, as used
direction is the Navrongo experiment (i.e. the Commu- in this context, is mainly in reference to the rigorous na-
nity Health Planning and Services (CHPS) concept). ture of the evidence produced as opposed to coverage
Lessons learnt from the Navrongo experiment were cru- (i.e. relevance to policy-makers or population health
cial to the scaling up of the CHPS concept, which needs). The rigour argument is based on the fact that
currently constitutes a key ‘Safe Motherhood’ strategy in funding organisations, such those indicated above, will
Ghana. There is also the possibility of the scaling up of normally ensure that research funded by them follow
capitation as a payment method across Ghana after ini- very rigorous standards.
tial piloting in the Ashanti region of the country. There Besides the output of the research centres, the findings
is also evidence to the effect that the decision to discon- indicate that staff from within the GHS are highly active
tinue vitamin A in pregnant women was based on re- contributors to the RCH literature in Ghana. Again, the
search that found that it did not have any significant existence of organisational and national level data
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 23 of 29
repositories that can easily be accessed and used by Further, evidence on the scaling up of RCH interven-
policy-makers to aid policy formulation is ample testi- tions based on lessons learnt from the pilot phase of
mony of the existence of high quality scientific research most of these projects is ample testimony that scientific
evidence that can be used to inform policy formulation. research evidence gathered from project execution con-
Additionally, the findings suggest that both GHS staff and stitutes a relevant input to policy formulation and imple-
other external collaborators perform scientific research mentation. As already indicated, the scaling up of the
within the GHS. Thus, the findings indicate to a certain Navrongo experiment (i.e. the CHPS concept) has had
systematic approach at the organisational level to enhance and will continue to have a profound impact on the na-
the production of evidence through scientific research. ture and type of strategies adopted to improve RCH out-
The existing institutional arrangements for the pro- comes in Ghana. The possibility of scaling up capitation
duction of evidence may, in some form, create oppor- as a payment mechanism for Ghana’s social health insur-
tunities for the use of evidence produced to inform ance from one region/province to national coverage is
policy. For example, there is evidence in the existing also important in this direction. Additionally, the refer-
knowledge transfer and utilisation literature [41] that encing of scientific research papers in the bibliography
suggests that policy-makers (1) are more likely to trust section of some of the policies, standard protocols and
evidence produced by their colleagues and therefore use practice guidelines is suggestive that findings from such
such evidence to inform policy, (2) use evidence from papers constituted a good piece of evidence used in the
research that involves them from planning to dissemin- formulation of the respective policies. On account of this
ation, (3) use evidence to inform policy if there is a win- evidence, one can suggest that capacity exists within the
dow of political opportunity to do so, and (4) are more GHS that makes it possible to use available scientific re-
likely to use evidence to inform policy if they have a bet- search evidence to aid the formulation and implementa-
ter link with the producers of evidence. Juxtaposing the tion of RCH policies.
results of the paper with prescriptions from the litera- Nevertheless, there are findings from the study that
ture as indicated above, one would expect that existing equally suggest the existence of constraints that can
GHS structures that promote the production of evidence compromise the ability of the GHS to use existing evi-
(activities of the research centres, individuals either dence to inform RCH policy. For instance, several of the
alone or in collaboration with others outside of the sec- policy documents and standard protocols and practice
tor) by actors within the health sector may mean better guidelines did not have any scientific research publica-
credibility for such evidence and, by extension, the pos- tion acknowledged in the list of references. For example,
sibility that it will be used to inform policy. Secondly, only 3 out of the 8 policy documents reviewed cited
the fact that these research centres/individuals are part scientific research papers. In the case of the standard
of the GHS should ordinarily make it easy for those in protocols and practice guidelines, only 5 out of the 15
charge of policy to have access to the producers of evi- documents reviewed cited the use of a scientific research
dence, thereby enhancing the plausibility that available paper. More importantly, those documents that cited
evidence will be used to inform policy formulation. scientific research papers did not explain the processes
On the contrary, the results paint a mixed picture. through which evidence emanating from these scientific
One set of evidence indicates that systematic organisa- papers was captured and used in either policy formula-
tional structures as well as individual capacity that tion or drafting of the standard protocols and practice
makes it relatively easy for policy-makers to use available guidelines. Equally important in this regard is the appar-
evidence in the formulation of RCH policies exist. For ent lack of both physical and electronic evidence that
example, project reports that capture the details (level of shows that findings from the numerous completed
policy-making, type of policy, nature of policy impact, projects as well as peer-reviewed publications have been
policy networks, political capital and inclusion in policy converted to a form that can be easily used by
documents) of how findings of executed projects have policy-makers (e.g. policy briefs or policy summaries).
been used in the formulation of policies is instructive. Additionally, the divergence of donor priorities and
The fact that almost all the standard protocols and those of policy-makers in terms of research may mean
practice guidelines are adaptations from benchmark doc- misalignment between evidence produced from research
uments issued by regulators or key institutions such as and information needed by policy-makers at a particular
WHO, UNICEF, UNFPA and the World Bank, which point in time. Thus, RCH evidence may be available (e.g.
rely highly on scientific evidence in the production of output of the research centres) and yet may not be use-
such guidelines, is also important. Thus, modelling RCH ful for decision-making. It is important to caution that
protocols and guidelines around documents of such in- the policy-maker/donor divergence in research priorities
stitutions suggests that such protocols and practice may not necessarily mean a misalignment between re-
guidelines are informed by evidence. search output of the research centres and population
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 24 of 29
health needs, given that research undertaken by the re- and informal structures that drive organisational learn-
search centres and individuals within the sector are all ing and norms that value the importance of evidence in
on issues of national relevance. Thus, the identified decision-making [15, 19] are key to the use of evidence
shortcomings should be viewed mainly as structural in policy-making. Thus, one can argue that the systems
weaknesses within the MOH and its agencies, specific- currently in place in the GHS, though not the very best,
ally the GHS, which constrain the use of evidence to in- constitute good organisational capabilities and strengths
form policy formulation, and not necessarily as evidence that could be leveraged upon to further improve the
to support the notion that policies and guidelines are capacity of the GHS in general, and the RCH division in
not informed by existing scientific research evidence. particular, to produce and use scientific research evi-
However, what seems to be clear from the evidence dence in the formulation of RCH policies and guidelines.
gathered so far with respect to the management of the Additionally, the fact that existing norms and beliefs
knowledge transfer processes in Ghana’s health sector within the health sector are consistent with knowledge
and, for that matter, RCH, is that apart from the actual production and transfer is important for improving
knowledge production component, the rest of the evidence-informed policy and practice.
process seems to be rather informal. For example, the The ability of researchers to summarise very compli-
key components of problem identification and commu- cated scientific language into simpler but easy and ready
nication, implementation of interventions and actual use to use material by policy-makers is seen as a key facilita-
of evidence do not follow any structured institutional tor of research uptake into policy [36]. In this context,
system. Additionally, funding for research is not cen- one can argue that the general inability to convert most
trally coordinated but mostly through an arrangement of the several scientific publications by the three re-
between individuals or clusters of researchers within the search centres into policy-friendly summaries or briefs
health system and donors. It is important to emphasise that can easily be used by policy-makers, coupled with
that these weaknesses have collective negative implica- the absence of appropriate scientific references in most
tions for establishing an appropriate monitoring and of the policy documents and practice guidelines, is indi-
evaluation framework to evaluate the knowledge produc- cative of internal organisational weaknesses. These weak-
tion process and how it is impacting policy formulation. nesses refer to the absence of systematic structures that
It is therefore not surprising that key performance indi- ensure that best practices are defined and followed.
cators used to evaluate sector-wide performance in Given that the standard protocols and practice guide-
Ghana do not capture knowledge production and trans- lines are adapted as indicated above, the main docu-
fer as an activity of interest to monitor [23, 24]. ments on which they are based should be adequately
cited and the evidence-based processes from which the
Strength, weaknesses, opportunities and threats main findings were synthesised should be transparently
A careful examination of the findings suggest that acknowledged and referred to in the new document.
Ghana, compared to many sub-Saharan African coun- A familiar argument within the knowledge transfer
tries, has made progress in producing evidence and and research utilisation literature has been the need to
using this to inform policy formulation. It is therefore bridge the cultural and institutional gap between re-
important that the strengths of the existing system are searchers and policy-makers, given that it constitutes a
highlighted and that appropriate measures are instituted major barrier to research uptake in policy formulation
to deal with inherent weaknesses and threats so as to [51–53]. Thus, the absence of a central structure from
take advantage of current and future opportunities to within the health sector to coordinate key knowledge
improve existing knowledge transfer processes in the production and transfer actors (policy-makers,
health sector. researchers and donors) as well as the absence of a
structured approach to define research needs and linking
Strengths and weaknesses these to ongoing research, constitute a major weakness
The findings are suggestive that, within Ghana’s health in the knowledge production and utilisation chain. On
sector and particularly in the RCH division of the GHS, the basis of the above and in line with Henkel [54], we
policy formulation is evidenced based. There is also argue that policy-makers within the MOH and its
enough evidence to suggest that the GHS has organisa- agencies may need to work hard not only to identify
tional level structures in place (the three research cen- problems but also to identify research that may help
tres) to aid the production of the required evidence to solve existing problems in addition to using the research
inform policy formulation. Also important is the fact output. Further, the fact that knowledge utilisation pro-
that the GHS has a critical mass of researchers who are cesses are not transparently defined and incorporated
extremely active in contributing to the production of sci- into organisational systems within the sector is also
entific knowledge in RCH. As earlier indicated, formal problematic. It is important to highlight that the absence
Abekah-Nkrumah et al. Health Research Policy and Systems  (2018) 16:75 Page 25 of 29
of an effective monitoring and evaluation function for important that the MOH and its agencies, especially the
knowledge production and, most importantly, for trans- GHS, take advantage of its current strengths and oppor-
fer and utilisation constitutes a system weakness. tunities (strong internal knowledge production capacity,
access to knowledge production networks outside of the
Opportunities and threats health sector, a positive environment for the promotion of
Outside of the internal structures there are clear oppor- evidence-informed policy, access to major donors with the
tunities that can be exploited by the GHS to improve on resources to fund good quality research, etc.) to confront
its uptake of scientific research evidence as inputs to the and address the structural and organisational weaknesses
policy formulation process. For example, the extensive inherent in the process of translating research evidence to
network of collaborations with researchers outside of the evidenced-informed policy. Specifically, there should be
GHS as well as access to major financiers (WHO, ILO, deliberate efforts to mainstream research in the health
Bill and Melinda Gates Foundation, Rockefeller Founda- sector so that an appropriate budget can be allocated to
tion, Pfizer Corporation, Volkswagen Foundation, fund research. The mainstreaming of research within the
National Institute of Health, World Bank, WAHO and sector could also help resolve the issue of the establish-
other bilateral and multilateral donors) of scientific re- ment of research priorities and their coordination between
search are all great opportunities that can be exploited researchers and policy-makers.
to improve internal structures for producing and using
good quality evidence to inform policy formulation and Abbreviations
CHPS: Community Health Planning and Services; DHRC: Dodowa Health
implementation. It is however important to emphasise Research Centre; EBM: Evidence-based medicine; GDHS: Ghana Demographic
that, to be able to take advantage of the opportunities and Health Survey; GDP: Gross Domestic Product; HE: Health expenditure;
enumerated, a major threat that ought to be managed ILO: International Labour Organisation; KHRC: Kintampo Health Research Centre;
MNCH: Maternal, newborn and child health; MOH: Ministry of Health;
well is the issue of funding. Issues around the nature NHRC: Navrongo Health Research Centre; POW: Programme of Works;
and source of funding, as well as the coordination and RCH: Reproductive and child health; WAHO: West African Health Organization
management of such funding, are crucial. The fact that a
larger proportion of funding for research in the health Acknowledgements
The authors will like to acknowledge colleague faculty members who read
sector comes from outside the health sector budget is a through the manuscript and offered various suggestions to improve the
threat to implementing any robust central coordinating paper. In the same breath, the authors acknowledge the West African Health
mechanism for knowledge production and transfer. Organization for funding the paper as well as the participants of the Accra
stakeholder meeting for the comments.
It is important that as Ghana’s strengths and oppor-
tunities for knowledge production and transfer are Funding
highlighted, effective and immediate steps are taken to The research was funded WAHO under contract number Prog-427-DRSIS-Pro-
address inherent weaknesses and threats to ensure that it gResearch-DRSIS/610/15/mbay as already indicated under the competing
interests section.
improves on the current system of producing evidence and
using it to inform the formulation of RCH policies. As Availability of data and materials
clearly articulated by the participants of the Accra stake- Data in the form of protocols and guidelines examined, websites and peer-
holder meeting, improving the knowledge transfer process reviewed journal articles included are all currently publicly available and canbe accessed based on the information given in the manuscript and the
is a collective task that must involve all stakeholders (key website of the GHS and the Ministry of Health in Ghana. Data with respect
among them being researchers, policy-makers and donors) to the interviews and questionnaire are captured in the original report and
with the health sector taking the lead. briefly also in this manuscript. The original report can be accessed from theWest African Health Organization on demand.
Conclusion Authors’ contributions
Issues of RCH and MNCH are important areas in the The four authors together conceptualised the paper. GAN, LV and JE developed
the instruments for data collection. GAN worked with LV and JE to collect data
strengthening health systems in developed and develop- for the paper. GAN proceeded to analyse the data collected and wrote the first
ing countries alike. In developing countries such as draft of the paper. SI provided comments that reshaped the paper to its current
Ghana, the issue is even more critical given that health form. GAN amended the paper to reflect the comments from SI and produced
the current version. All authors read and approved the final manuscript.
systems are generally weak and have low levels of invest-
ment and poor RCH indicators, especially during the Ethics approval and consent to participate
1990s. However, the implementation of pragmatic pol- The study was performed under the auspices of the Ghana Health Service (GHS)
icies and commitment of health sector managers over al- and the West African Health Organization (WAHO) at the administrative level. The
requisite permission to interview staff of the GHS was sought by the WAHO as
most two decades has ‘paid off ’ in terms of tremendous part of the study. Other participants who interacted with the researchers also
improvement in the state of RCH. granted consent and were willing to participate in the interviews. Additionally,
Nevertheless, Ghana still has challenges in RCH and those who answered questionnaires during the stakeholder meeting in Accra also
granted consent and willingly participated. Formal ethical approval was not
further efforts to improve RCH policy-making processes sought given that the GHS gave administrative approval in addition to the fact
are likely to yield even better results. It is therefore that the study did not deal with any clinical staff.
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