Miscellaneous Knowledge Notes

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  • Publication
    Networks of Practice in Urban Ghana: Design and Implementation - Key Lessons from Formative Research in Ayawaso Central and Atwima Nwabiagya Municipal
    (Washington, DC: World Bank, 2025-01-03) World Bank
    This brief presents insights and lessons for the Networks of Practice (NoP) program in urban Ghana, based on formative research conducted in Ayawaso Central, Greater Accra Region and Atwima Nwabiagya Municipal, Ashanti Region. The research used Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to understand and compare patient journeys in settings with and without NoPs. The NoP program has not yet expanded into urban areas, but studying patient journeys and the healthcare provider situation in urban settings provides essential information for patient oriented NoP design. Features that were found to be specific to urban districts include a higher density of health providers, a greater role of private health facilities and clinics as compared to rural areas, and higher out-of-pocket expenditure on healthcare. For successful NoP implementation, network formation in urban areas will need to be tailored to the prevailing care delivery landscape and healthcare utilization patterns. This may include upgrading selected public sector facilities to become network hubs and enhancing collaboration with private sector providers to strengthen urban networks. Urban NoPs can advance Ghana’s ambition to increase access to quality primary care, robust referral pathways, and financial protection for all healthcare users in the country. Further research in various urban and peri-urban districts of Ghana and implementation of urban NoP pilots will be beneficial for shaping an NoP program suited to urban health systems
  • Publication
    Networks of Practice in Ghana: Learning from Implementation in Two Districts Key Lessons from Research in Dormaa Central and Hohoe Districts
    (Washington, DC: World Bank, 2025-01-02) World Bank
    The research conducted in Dormaa Central and Hohoe districts in Ghana provided several key findings regarding the Networks of Practice (NoP) program. The study included Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to understand and compare patient journeys and network configurations between districts with NoPs and those without. In Dormaa Central, four NoPs were established in November 2020 with USAID/R4D support, while in Hohoe, three NoPs were started in January 2021 with KOFIH support. The research revealed notable positive effects of NoPs in the delivery of health services, including facility-level improvements, service enhancements, and increased collaboration between health facilities. However, some key goals of NoPs, such as strong referral gatekeeping to reduce the patient load at higher-tier facilities, were not fully achieved. Patient preference for higher-tier facilities persisted due to perceived quality and the spectrum of services available at different levels of care. Despite this, districts with NoPs showed a shift towards increased utilization of health centers that were NoP hubs. The study also highlighted improved awareness of the hub and spoke model of care, willingness, and evidence of cross-facility collaboration and sharing of resources.