Factors constraining the scale up of the Navrongo Experiment's fertility impact in northern Ghana

Ghana’s Community Health and Family Planning (CHFP) Project demonstrated dramatic success in the 1990s in reducing fertility and saving lives by posting nurses in rural villages where they worked with traditional social networks to deliver community-based health services. The CHFP approach was scaled up as a national program called “Community-based Health Planning and Services” (CHPS) and is now a major contributor to Ghana’s health care system. However, vital reproductive health components are languishing and CHPS’ impact on fertility may be falling well short of the potential to address unmet need. This qualitative study revisited the villages of the CHFP in order to clarify social and behavioral changes that have occurred and not occurred as CHPS services were scaled up. Preliminary analysis reveals that key functions of the health system that fostered community engagement have atrophied during the scale-up of CHPS. Limited human and financial resources and additions to the package of CHPS services have diluted the focus on family planning and reduced the time and energy available for community engagement for family planning uptake. Activities to change community attitudes toward family planning appear to be more fragile and difficult to sustain than other components of CHPS services in the face of resource constraints.