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From “Innovation for Localization” to “Local Philanthropy, Localization and Power”

November 17, 2022

n 2021, five organizations – Save the Children Denmark, Network for Empowered Aid Response (NEAR), West Africa Civil Society Institute (WACSI), STAR Ghana Foundation (SGF) and the Global Fund for Community Foundations (GFCF) participated in an ambitious and experimental joint project.The aim of the project was to "test durable, locally rooted funding mechanisms" in Somalia and Ghana, with the broader purpose of contributing – by demonstration – to efforts within the international humanitarian aid and development sector to transform and localize aid. The purpose of this learning report, curated by the GFCF, is to capture some of the main insights and reflections ofthe participating organizations and to consider the broader implications of and lessons from the project. It focuses on the experiences of those involved and the larger question of how unorthodox configurations of actors and new and different kinds of partnerships might contribute towards transformative change within the international aid system. 

“You Can’t Look at an Orange and Draw a Banana”: Using Research Evidence to Develop Relevant Health Policy in Ghana

September 15, 2022

We examined factors that either enabled or inhibited the process of evidence-based decision making regarding health policy in Ghana. We conducted qualitative interviews with 2 major groups of stakeholders: health policy and systems research producers (research producers [RPs]) and policy makers (PMs). In-depth interviews were conducted with 12 RPs, who were representatives from 11 health policy and systems research institutions; and 12 PMs working in various national health-related agencies, ministries, and departments. We analyzed the data using the thematic analysis approach. Interview results showed 5 recurring themes in their discussion of enablers and inhibitors of the evidence-to-policy process: (1) the quality, relevance, and quantity of available research evidence; (2) how findings are communicated to PMs; (3) the strength of relationships between RPs and PMs; (4) available structures that promote evidence-based policy making; and (5) the political context in which research and policy making occurs. These findings point to some specific areas for further collaboration and communication among Ghanaian stakeholders to ensure that appropriate health policies are developed from an evidence base.

Using Health Systems and Policy Research to Achieve Universal Health Coverage in Ghana

September 15, 2022

Ghana is positioned to become the first country in sub-Saharan Africa to implement universal health coverage based on nationwide expansion of geographic access through the Community-based Health Planning and Services initiative. This achievement is the outcome of 3 decades of implementation research that health authorities have used for guiding the development of its primary health care program. This implementation research process has comprised Ghana's official endorsement of the 1978 Alma Ata Declaration, leading to the institutionalization of evidence relevant to the strategic design of primary health care and national health insurance policies and services. Rather than relying solely upon the dissemination of project results, Ghana has embraced a continuous and systemic process of knowledge capture, curation, and utilization of evidence in expanding geographic access by a massive expansion in the number of community health service points that has taken decades. A multisectoral approach has been pursued that has involved the creation of systematic partnerships that included all levels of the political system, local development officials, community groups and social networks, multiple university-based disciplines, external development partners, and donors. However, efforts to achieve high levels of financial access through the roll-out of the National Health Insurance Scheme have proceeded at a less consistent pace and been fraught with many challenges. As a result, financial access has been less comprehensive than geographical access despite sequential reforms having been made to both programs. The legacy of activities and current research on primary health care and national health insurance are reviewed together with unaddressed priorities that merit attention in the future. Factors that have facilitated or impeded progress with research utilization are reviewed and implications for health systems strengthening in Ghana and elsewhere in Africa and globally are discussed.

Health Policy and Systems Research Capacities in Ethiopia and Ghana: Findings From a Self-Assessment

September 15, 2022

Introduction: Health systems are complex. Policies targeted at health system development may be informed by health policy and systems research (HPSR). This study assesses HPSR capacity to generate evidence and inform policy in Ethiopia and Ghana.Methods: We used a mixed-methods approach including a self-administered survey at selected HPSR institutes and in-depth interviews of policy makers.Results: Both countries have limited capacity to generate HPSR evidence, especially in terms of mobilizing adequate funding and retaining a critical number of competent researchers who understand complex policy processes, have the skills to influence policy, and know policy makers' demands for evidence. Common challenges are limited government research funding, rigidity in executing the research budget, and reliance on donor funding that might not respond to national health priorities. There are no large research programs in either country. The annual number of HPSR projects per research institute in Ethiopia (10 projects) was higher than in Ghana (2.5 projects), Ethiopia has a significantly smaller annual budget for health research. Policy makers in the 2 countries increasingly recognize the importance of evidence-informed policy making, but various challenges remain in building effective interactions with HPSR institutes.Conclusion: We propose 3 synergistic recommendations to strengthen HPSR capacity in Ethiopia and Ghana. First, strengthen researchers' capacity and enhance their opportunities to know policy actors; engage with the policy community; and identify and work with policy entrepreneurs, who have attributes, skills, and strategies to achieve a successful policy. Second, deliver policy-relevant research findings in a timely way and embed research into key health programs to guide effective implementation. Third, mobilize local and international funding to strengthen HPSR capacities as well as address challenges with recruiting and retaining a critical number of talented researchers. These recommendations may be applied to other low- and middle-income countries to strengthen HPSR capacities.

Barriers and Facilitators to Data Use for Decision Making: The Experience of the African Health Initiative Partnerships in Ethiopia, Ghana, and Mozambique

September 15, 2022

Background: Three African Health Initiative (AHI) partnership projects in Ethiopia, Ghana, and Mozambique implemented strategies to improve the quality and evaluation of routinely collected data at the primary health care level and stimulate its use in evidence-based decision making. We compare how these programs designed and carried out data for decision-making (DDM) strategies, elaborate on barriers and facilitators to implementation success, and offer recommendations for future DDM programming.Methods: Researchers from each project collaboratively wrote a cross-country protocol based on these objectives. By adapting the Consolidated Framework for Implementation Research (CFIR) through a qualitative theme reduction process, they harmonized lines of inquiry on the design of the respective DDM strategies and the barriers and facilitators of effective implementation. We conducted in-depth interviews and focus group discussions with stakeholders from the primary health care systems in each country, and we carried out multistage, thematic analyses using a deductive lens.Results: Effective implementation of DDM depended on whether implementers felt that DDM was adaptable to context, feasible to trial, and easy to introduce and maintain. The prevailing policy and political environment in the wider health system, learning climate and absorptive capacity for evidence-based change in DDM settings, engagement of external change agents and internal change leaders, and promotion of opportunities and means for team-based reflection and evaluations of what works influenced the success or failure of DDM strategies.Conclusion: Opportunities for team-based capacity building and individual mentorship led to effective DDM programming. External policies and associated incentives bolstered this but occasionally led to unintended consequences. Leadership engagement and availability of resources to act on recommendations; respond to capacity-building needs; and facilitate collaborations between peers, within hierarchies, and across the local health system proved crucial to DDM, as was encouraging adaptation and opportunities for iterative on-the-job learning.

Improving Primary Care Quality Through Supportive Supervision and Mentoring: Lessons From the African Health Initiative in Ethiopia, Ghana, and Mozambique

September 15, 2022

Introduction: Supportive supervision and mentoring (SSM) is crucial to primary care quality and effectiveness. Yet, there is little clarity on how to design and implement SSM and make it sustainable in primary health care (PHC) systems. The 3 African Health Initiative partnership projects introduced strategies to do this in Ethiopia, Ghana, and Mozambique. We describe: (1) how each partnership adapted SSM implementation strategies, (2) the dynamics of implementation and change that ensued after intervening within PHC systems, and (3) insights on the SSM sustainability as a mainstay of PHC.Methods: Researchers from each project collaboratively wrote a cross-country protocol based on those objectives. For this, they adapted implementation science frameworks—the Exploration, Preparation, Implementation, and Sustainment model and the Consolidated Framework for Implementation Research—through a qualitative theme reduction process. This resulted in harmonized lines of inquiry on the design, implementation, and potential sustainability of each project's SSM strategy. In-depth interviews and focus group discussions were conducted with stakeholders from PHC systems in each country and thematic analyses ensued.Results: Across the projects, SSM strategies acquired multiple components to address individual, systems, and process-related determinants. Benefits arose from efforts that addressed worker-level attitudes and barriers, promoted a wider learning environment, and enhanced collaborative structures and tools for monitoring performance. Peer exchanges and embedded implementation research were critical to the perceived effectiveness of SSM strategies.Discussion: Despite differences in their approach to SSM implementation, there are common crucial ingredients across the SSM strategies of the 3 AHI partner projects from which important lessons arise: (1) positioning learning and adaptation opportunities within the routine workings of PHC systems, facilitation, and technical support to reflect and utilize new knowledge; (2) multisectoral collaboration, particularly with academic organizations; and (3) building PHC decision-makers' and implementation teams' capacity for evidence-informed change.

Embedding Research on Implementation of Primary Health Care Systems Strengthening: A Commentary on Collaborative Experiences in Ethiopia, Ghana, and Mozambique

September 15, 2022

Achieving universal health care coverage requires the adoption of primary health care policies and delivery strategies that are evidence based. Although this has been confronted by manifold challenges, particularly in the health systems of sub-Saharan Africa, there are promising approaches for accomplishing this objective. Salient among these is embedding implementation research (i.e., the study of methods to promote the systematic uptake of evidence-based interventions (EBIs) into routine practice) into policy making and implementation processes. Since 2007, the African Health Initiative of the Doris Duke Charitable Foundation supported partnerships that strengthened primary health systems and policy implementation in 7 countries in sub-Saharan Africa using the embedded implementation research as a core strategy. This programmatic review and analysis aims to identify the core features and processes that characterized how the partnerships operationalized the embedded implementation research approach and understand the factors that helped and constrained partnerships' effective use of this approach. For this, we drew upon findings from a desk review that consisted of 30 examples of embedded implementation research conducted by 3 African Health Initiative partnerships between 2016 and 2021 in Ethiopia, Ghana, and Mozambique. In addition, we conducted and analyzed 13 in-depth interviews with embedded implementation research stakeholders of the 3 projects.Core features and processes of embedded implementation research were: (1) the leadership role of policy decision makers and implementation leaders; (2) positioning research with program implementation at multiple levels of health systems; (3) multidisciplinary and multisectoral partnerships; (4) focus on research capacity building; and (5) real-time feedback loops and knowledge translation.Factors influencing the effectiveness of the embedded implementation research experiences involved: (1) the implementation climate and leadership; (2) opportunities and capacities to circulate and absorb new information; and (3) stakeholders' baseline knowledge and embedded scientists' identification within their organizations.

Learning Health Systems to Bridge the Evidence-Policy-Practice Gap in Primary Health Care: Lessons From the African Health Initiative

September 15, 2022

The authors provide a brief history of the African Health Initiative and introduce the articles of the Global Health: Science and Practice journal supplement, highlighting the importance of evidence-based interventions (EBI) in global health and summarizing key takeaways.

Civil Society Organisations’ Contributions to National Development in Ghana

March 23, 2022

This report analyses the role and contributions of civil society organisations (CSOs)1 to Ghana's national development. In doing so, the report focuses on CSOs' engagements with and contributions to the Coronavirus disease (COVID-19) responses and post-pandemic recovery. It also discusses the barriers facing CSOs in their attempt to contribute to national development and towards a desired future post COVID-19 in Ghana. 

Forgotten by Funders

December 1, 2021

This report highlights the underfunding of work with and for imprisoned and formerly imprisoned women and girls,  alongside a worrying increase in the global female prison population. The report draws from the survey responses of 34 organisations, most of which are based in the Global South and have women with lived experience of the justice system involved with or leading their work. Calling to donors that fund human rights, women's rights and/or access to justice, the report concludes that this heavily gendered area of human rights tends to fall through the cracks of donor strategies, including recent Gender Equality Forum pledges. 

Localisation Agenda, Shift the Power and African Philanthropic Models in Burkina Faso, Ghana, Nigeria and Senegal

October 19, 2021

This report presents the findings from a qualitative empirical research undertaken by the West Africa Civil Society Institute and Global Fund for Community Philanthropy aimed at understanding localisation agenda and shift the power as mechanisms to strengthen power and resource flow to local and local civil society organisations (CSOs) working in Burkina Faso, Ghana, Nigeria and Senegal. The report also seeks to develop a better understanding of how African CSOs including philanthropic organisations understand localisation agenda and shift the power, and to support growing efforts to build a future of increased localised humanitarian action and a balanced power where there is equal opportunities and well-balanced resource between donors and CSOs in the humanitarian aid system. The report further examines the role of African philanthropic organisations and the added value and challenges of pooled or intermediary funding mechanisms in promoting the localisation agenda and shift the power.This report draws on data from semi-structured interviews conducted with sixteen participants who are experts and professionals working within the development and humanitarian aid sectors. The participants were drawn from CSOs including philanthropic organisations at three geographical levels: Global, Africa and West Africa. 

A Synthesised Report on the Impact of the Coronavirus Disease (COVID-19) Pandemic on Civil Society Organisations in West Africa

July 5, 2021

This report presents a synthesis of the findings on the impact of the Coronavirus Disease (COVID-19) pandemic on civil society organisations (CSOs) in West Africa, with particular focus on Cameroon, The Gambia, Ghana, Liberia, Nigeria, and Sierra Leone. In particular, the report document show the COVID-19 pandemic has affected CSOs' operations, funding prospects and relationships with donors and stakeholders. Given that CSOs are agile actors with an agency, this report further analyses' strategic responses for mitigating the effects of the pandemic in ensuring their short-term survival and long-term sustainability. The findings, therefore, present data-based evidence to inform stakeholders' engagement with West African CSOs.The implications of the findings for policy and practice are further discussed.The findings in this study are informed by a sequential explanatory mixed-method design which involves first collecting and analysing the quantitative data followed by qualitative data. As part of the quantitative phase of this study, a survey questionnaire was administered to 313 CSOs across the six countries (i.e., Cameroon – 36 CSOs; The Gambia-16 CSOs; Ghana-86CSOs; Liberia-27 CSOs; Nigeria-80 CSOs; and SierraLeone-68 CSOs) between June and July 2020. Following the quantitative data administration and analysis,6 focus group discussions were conducted with 48 CSOs who first participated in the quantitative phase between July and September 2020. Additional, key informant interviews were conducted as part of the data collection in each country. The final analysis in this report integrated the quantitative and qualitative data, which provided nuanced perspectives on the impact of COVID-19 on CSOs' in West Africa.