Transforming Healthcare in Ghana: Networks of Practice Driving Universal Health Coverage

The Networks of Practice (NoPs) initiative in Ghana, supported by the World Bank and Ghana Health Services, aims to enhance primary healthcare delivery by fostering collaboration among facilities, improving accessibility, and optimizing resources. While NoPs have improved service delivery and patient trust, addressing workforce shortages, referral gaps, and infrastructure needs remains crucial for achieving Universal Health Coverage.

The World Bank, in collaboration with Ghana Health Services and other research partners, has undertaken a comprehensive analysis of Networks of Practice (NoPs) in Ghana’s healthcare system. Designed to enhance primary healthcare delivery and drive the nation toward Universal Health Coverage (UHC), the NoP initiative addresses critical gaps in healthcare provision. Ghana has made considerable progress in health sector reforms, including decentralization, telemedicine, and the overhaul of its national health insurance scheme. However, persistent challenges such as inadequate infrastructure, inefficient referral systems, and limited access to healthcare in rural areas hinder progress. NoPs aim to create interlinked networks of healthcare facilities, organized around a hub-and-spoke model, to improve accessibility, reduce service fragmentation, and optimize resource use.

Expanding NoPs to Strengthen Service Delivery

From 2017 to 2019, the Ghana Health Service (GHS) and Ministry of Health (MoH), supported by the United States Agency for International Development (USAID), piloted the Primary Care Provider Networks project. This initiative evaluated the feasibility of structured healthcare networks designed to provide accessible and quality care at all levels. The hub-and-spoke model ensures that hubs deliver comprehensive care while smaller spokes offer basic services, referring complex cases to hubs when necessary. Following the pilot’s success, the government scaled up the initiative to ten districts in 2020, and in 2024, published detailed implementation guidelines to expand NoPs nationwide. The study used Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) across selected districts to assess how NoPs impact care pathways, focusing on maternal and neonatal health (MNH) and hypertension (HTN).

Insights into Patient Behavior and Health System Impact

Findings revealed that NoP districts exhibited higher utilization of mid-tier healthcare facilities, such as health centers, compared to non-NoP areas. For instance, MNH patients in NoP districts demonstrated a consistent preference for health centers, transitioning seamlessly between antenatal care and facility deliveries within these hubs. Similarly, HTN patients in NoP districts relied more on health centers for routine monitoring and treatment maintenance than their non-NoP counterparts. These results suggest that the strengthened capacity of health centers under the NoP model has bolstered patient trust and shifted care-seeking behaviors away from overburdened hospitals. However, significant barriers remain, including a lack of workforce capacity, inconsistent referral systems, and patient preferences for higher-tier hospitals, driven by perceptions of superior care quality and availability of diagnostic services.

The study also examined dimensions of healthcare access shaped by NoP implementation, such as affordability, availability, and approachability. While NoPs reduced indirect costs like travel expenses and strengthened resource sharing, gaps persist, particularly in urban areas where private healthcare dominates and out-of-pocket expenses remain a significant burden. Moreover, rural districts face unique challenges, including inadequate deployment of healthcare workers and long travel times for patients. Addressing these disparities requires continued investments in health worker recruitment, capacity building, and infrastructure improvements.

Key Recommendations for Scaling Up NoPs

To optimize the performance of NoPs, the report provides several recommendations. Advocacy campaigns are essential to increase public trust and awareness about the benefits of NoPs. Mapping networks with patient input can ensure that services align with local needs, while routine feedback mechanisms and continuous learning initiatives can refine network operations. Stakeholders highlighted the need for better resource allocation, recruitment of additional healthcare professionals, and upgrading diagnostic capacities across all tiers of care. Expanding insurance coverage and addressing out-of-pocket expenses, particularly in urban regions, will also be critical for sustaining the initiative’s success. Community involvement emerged as a cornerstone for NoP sustainability, with strategies such as community health management committees and public education campaigns playing pivotal roles in fostering accountability and local support.

Advancing Ghana’s Goal of Universal Health Coverage

The implementation of NoPs represents a transformative step in strengthening Ghana’s healthcare system. By fostering collaboration, improving accessibility, and reducing service fragmentation, NoPs are helping Ghana move closer to achieving UHC. Despite challenges, the initiative has already delivered significant benefits, including improved collaboration among facilities, enhanced service delivery, and increased patient trust in mid-tier facilities. However, realizing the full potential of NoPs will require addressing systemic gaps, such as workforce shortages, weak referral systems, and inadequate infrastructure. Tailoring NoPs to urban contexts, where the healthcare ecosystem involves a diverse mix of public and private providers, is especially important.

The study’s findings serve as a roadmap for scaling up NoPs nationwide, ensuring the initiative remains responsive to local healthcare needs. With continuous adaptation and stronger partnerships between government agencies, private providers, and communities, NoPs can achieve sustainable success. This initiative is not only a testament to Ghana’s commitment to healthcare reform but also a vital strategy for delivering equitable, high-quality healthcare to all citizens. By addressing current gaps and leveraging the strengths of NoPs, Ghana is poised to achieve significant strides in health outcomes and access, ensuring no one is left behind in the journey toward UHC.