The application of embedded implementation science to developing community-based primary health care in Ghana

Successful experiments for developing community-based health services often end without contributing to reform of large-scale programme implementation. In Ghana, however, the national implementation of community-based primary health care services, policy formation and action has been grounded in a continuous process of evidence-based planning. Originally launched as a three-village pilot project located in a single rural district, community-based health care in Ghana currently reaches over 3,000 communities dispersed in all 212 districts. This successful expansion of evidence-based health care has been the outcome of embedding science into the management systems. Beginning with diagnostic systems research and followed by phases for experimentation, replication, and scaling-up, the implementation of community-based primary health care has been guided by science that aims to improve the pace of programme expansion, the quality and intensity of community-based care, and reform of national operations when problems arose. In this process, embedding implementation science into routine national programming has sustained research utilization, clarified milestones, and accelerated the pace of scaling up progress. By providing insights into practical actions that can improve functioning, results from embedded research function as a component of programme management rather than something that researchers are challenged to hand over to policy makers and managers.