Making sure that health interventions benefit all those in need is a key challenge for LMICs.

Case study 3: Building sustainable implementation research in the Ghana Health Service.

Background: Ghana has steadily embedded implementation research (IR) in its health system through sustained country-led capacity building and sustained efforts by the Ministry of Health (MoH) and the Ghana Health Service (GHS). Over a period of almost 20 years, successive leadership has engaged stakeholders at the national and international levels to identify bottlenecks in the health system and address them with varying degrees of success. Most recently, the GHS led the development of a national health research agenda and an IR capacity plan for some key disease control programmes, with support from a multilateral partnership on access and delivery of health interventions.

In order to strengthen capacity within the GHS for implementation and operational research to identify and address country-specific health system needs for effective access to and delivery of new health technologies, a series of national workshops and stakeholder activities were conducted serially over a period of 18 months by the Research and Development Division (RDD) of the GHS. These included the development of a National Health Research Agenda so that the priority research areas identified by the GHS, its stakeholders and other collaborators could develop and provide evidence to support decision-making. Over one hundred and fifty development partners, GHS Directors and Deputy Directors, MoH Directors, Scientists from GHS research institutions, the Noguchi Memorial Institute for Medical Research, staff of the School of Public Health, Staff of non-GHS research institutions, policy-makers, disease control programme managers, Regional Directors, District Directors, Regional and District level Health Staff, Academics, and Health Administrators all contributed to the development of the research agenda, and participated in various workshops and stakeholders' meetings to review and refine the emerging research priorities. The resulting National Health Research Agenda included a list of barriers and problems impeding the effective delivery of health programmes and implementation of policies. The list provided a practical point at which IR can begin and focus.

A second series of workshops were conducted after the initial stakeholder consultation on the research agenda. These workshops were designed to:

  • sensitize policy-makers at the GHS on the importance of IR to address priority programme needs;
  • sensitize key players of the African Regional Training Centre (RTC) at the University of Ghana on the value of IR to address priority programme needs;
  • build capacity in cohorts of research teams for the conduct of IR and dissemination of research findings in public health; and
  • promote teamwork and functional partnerships among researchers, disease programme implementers and policy-makers.

Development of a national health research agenda for Ghana

Ghana has a rich history of health services research, with strong institutional arrangements for the coordination of research efforts in the country. The Health Research Unit, established in 1990 serves as the main coordination mechanism for health research and has evolved over time to the Research and Development Division (RDD) of the GHS. Research has always been accorded a high priority to support the successive Health Sector Five-Year Programmes of Work, starting with the first programme of work in 1996. In 1998, the Government published Policy guidelines for strengthening research in support of the First Medium-Term Health Strategy in Ghana. The second five-year Programme of Work (2002–2006) had its own five-year research programme, aligned with the Medium-Term Health Strategy for Ghana (2002–2006). Successive health sector programmes had strong research components, and in 2008, a health research agenda was published to accompany the programme of work.

In 2004, the GHS/RDD developed a health research agenda for 2015–2018 with the support of partners (WHO/TDR and the United Nations Development Programme) to underpin the 2014–2017 Health Sector Medium Term Development Plan. The process involved high-level stakeholders' meetings organized by the GHS in collaboration with other partners, in order to obtain input on a draft national health research agenda covering 2015 to 2018. A draft document was produced and reviewed at a subsequent stakeholders meeting. The revised document was finalized and published by the GHS as the Ghana National Health Research Agenda 2015 – 2019.

Sensitization workshops for policy-makers and Regional Training Centre staff

A one-day workshop was convened for Directors and Deputy Directors of the various divisions in the GHS. The workshop sensitized and familiarized top management of the GHS to the key concepts of and approaches to IR and its potential value in addressing the key health system challenges in the country. Being slightly removed from the implementation level, it was imperative that policy-makers appreciated the value of IR in addressing implementation challenges encountered by programme managers at the district level. The second component of the sensitization process was to engage academia at the School of Public Health, University of Ghana and to sensitize key players on the content and processes of IR.

Training workshop for national control programmes

Following the sensitization of policy-makers, attention shifted to front-line practitioners of three priority programmes of the GHS: the National Malaria Control Programme (NMCP), National Neglected Tropical Diseases Control Programme (NTDCP), and the National Tuberculosis and Leprosy Control Programme (NTLP). Workshops were designed to equip programme teams to undertake IR on obstacles to the effective and efficient delivery of programme interventions. These obstacles were previously identified during the stakeholder consultations for the development of the national health research agenda.

A comprehensive plan was put in place to equip the research teams constituted by the priority control programmes through a series of national workshops – from the identification of research problems through to the development of robust study protocols, conduct of the research, data analyses, and preparation and dissemination of results (Figure).

Figure. Planning for building IR capacity among priority programme managers

The programme managers constituted teams for the workshops on training and proposal development. Teams comprised a key member of the control programme, respective information officers, and researchers with quantitative and quantitative skills and an interest in the programme.

The workshop helped research teams to start the process of executing IR to address priority problems identified by national control programmes in Ghana. A number of programmes were able to provide funding within their programme budgets to support the resulting research projects.

Lessons: Engagement of key stakeholders in the health sector and research community in the identification of barriers, and development of the national health research agenda, facilitated wider appreciation of the value of IR in achieving national health outcomes. Funds were allocated within the national programme budget(s) to support IR without dependence on external sources.