Strengthening Ghana's Healthcare: The Impact of Networks of Practice

Ghana’s healthcare sector is transforming the Networks of Practice (NoP) initiative, a model designed to decentralize services and improve accessibility. A new World Bank report highlights NoPs’ impact on maternal and hypertension care, showing increased health center utilization in NoP districts. However, challenges such as referral inefficiencies, workforce shortages, and infrastructure gaps persist. The report provides actionable recommendations to strengthen NoPs, emphasizing workforce expansion, facility upgrades, and better patient education. If scaled effectively, NoPs could be a game-changer in achieving Universal Health Coverage in Ghana.

Ghana’s health sector is evolving, with a new approach aimed at transforming primary healthcare access and efficiency. A recent report, Health System Technical Support to the Government of Ghana: Patient Pathway Analysis and Summative Network Analysis, published by the World Bank, delves into the effectiveness of Networks of Practice (NoPs) in the country’s health system. This initiative seeks to address healthcare disparities, particularly in maternal and neonatal health (MNH) and hypertension (HTN) services, through better coordination and resource sharing.

A New Approach to Healthcare Access

For years, Ghana has led West Africa in health sector investment and reform. From decentralization and telemedicine integration to national health insurance improvements, the country has made significant strides. However, infrastructure gaps, limited primary healthcare capacity, and weak referral systems still hinder progress, especially in rural communities. The introduction of NoPs aims to bridge these gaps by improving service collaboration and accessibility.

Launched in 2024, the NoP model builds on a successful pilot program that demonstrated the value of Primary Care Provider Networks (PCPNs). NoPs function as interconnected health service delivery hubs, promoting teamwork among medical professionals and ensuring better patient referrals.

Findings: How Patients Navigate the Health System

The study analyzed six districts—both urban and rural—focusing on how patients access MNH and HTN services. Findings showed that hospitals remain the preferred choice for treatment, even for routine services that should be available at lower-tier facilities. In NoP districts, health centers saw higher utilization rates, indicating that strengthened service hubs encouraged patients to seek care closer to home.

For MNH care, women preferred hospitals for antenatal visits and delivery, citing quality and trust in service providers as major factors. In rural areas, health centers played a larger role, whereas urban patients gravitated toward private clinics and NGO-run facilities.

HTN patients followed a similar pattern, with hospital-based care dominating despite the availability of primary care services. Notably, only 1.2% of patients entered hypertension care through preventive screening, highlighting a missed opportunity for early intervention. NoP districts, however, showed greater engagement with primary care, suggesting the model’s potential to decentralize services effectively.

Challenges Hindering Healthcare Accessibility

While NoPs have improved coordination, challenges persist. Key barriers include:

Limited referral enforcement: Patients often bypass lower-tier facilities, leading to overcrowded hospitals.

Workforce shortages: Rural areas struggle with a lack of trained medical personnel.

High out-of-pocket expenses: Urban patients rely more on private facilities, increasing financial strain.

Infrastructure constraints: Many NoP hubs lack the necessary equipment and transportation for timely referrals.

A Blueprint for Strengthening NoPs

The report outlines key recommendations to optimize NoP performance:

Expand workforce recruitment with incentives for rural service.

Upgrade primary care facilities to improve diagnostics and treatment capacity.

Enhance patient education on the benefits of NoP hubs and health centers.

Improve referral enforcement to ensure patients receive care at appropriate levels.

Scale up NoPs in urban settings by integrating private-sector partnerships.

Community Engagement: Validating the NoP Model

The study also incorporated feedback from healthcare workers and patients, revealing strong support for NoPs. Respondents highlighted improvements in drug availability, referral efficiency, and facility collaboration. However, concerns over long wait times and workforce shortages emphasized the need for further investment and policy refinement.

NoPs as a Pathway to Universal Health Coverage

Ghana’s commitment to NoPs represents a crucial step toward achieving Universal Health Coverage (UHC). By fostering collaboration, decentralizing services, and addressing infrastructure gaps, the country is laying the groundwork for a more equitable and efficient healthcare system. As NoPs expand nationwide, continuous evaluation and strategic investment will be essential in ensuring that all citizens—regardless of location or socioeconomic status—receive quality healthcare.

The full findings and recommendations are detailed in Health System Technical Support to the Government of Ghana: Patient Pathway Analysis and Summative Network Analysis, published by the World Bank. This comprehensive analysis provides a roadmap for strengthening Ghana’s healthcare landscape and advancing the nation’s health goals.