Can Community Health Services Offset the Effect of Poverty and Low Maternal Educational Attainment on Childhood Mortality? Evidence from the Navrongo Experiment in Northern Ghana

The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. Originally launched as an experimental project of the Navrongo Health Research Centre, CHPS is currently a national initiative for shifting the focus of primary health care from clinics to communities. Four contrasting strategies of community health care were tested. In response to early evidence that community nursing could impact on survival, CHPS was launched to scale up the Navrongo community health service delivery system. The program currently functions in over 1000 villages dispersed in all 172 districts of Ghana. This paper presents a longitudinal demographic survival histories of 17,967 under age five children who were observed over the July 1993 to December 2010 period. Analysis of trends show that placing nurses in CHPS communities was associated with more pronounced mortality declines than was observed in comparison communities. Differentials show that Navrongo study areas exhibit equity relationships that are often observed elsewhere in Africa: Children whose parents are uneducated and relatively poor experience significantly higher mortality than children of the educated and less poor. Time conditional We