Abstract
Patient-Public Engagement (PPE) has been recognised in Ghana, especially through major healthcare policies and legislation, as a key strategy to improve the health system. Yet, little is known about how effectively PPE is functioning in Ghana, including the various factors that facilitate or impede its successful implementation. This study, therefore, explores the role of PPE in health system improvement in Ghana by understanding its functioning within the various health system levels, the strategies for effective PPE implementation, the effects of PPE on health system improvement, and the key factors that support or impede PPE in Ghana.
Using a case study design, six communities, located in three different districts in the Ashanti Region of Ghana were selected for this study. Prior to the qualitative case study, a systematic scoping review of PPE literature was conducted to describe the variety of outcomes following PPE interventions, the health system levels at which PPE was functioning, and the identified PPE facilitators and barriers in Sub-Saharan Africa. The key knowledge gaps identified from the scoping review also helped inform the focus of the qualitative data collection.
The qualitative case study was undertaken in two phases. The first phase focused on the general functioning of PPE in Ghana – including describing the strategies employed for PPE as well as the key PPE barriers and facilitators. Document reviews and semi-structured individual interviews were employed in each of the six case study sites involving 35 participants whose various roles were linked to PPE within the different health system levels. In the second phase of the qualitative case study, the role of PPE was further explored in three selected community-based health intervention programmes (Community-Based Health Planning and Services programme; Community-Based Maternal and Child Health programme; and Buruli Ulcer programme). A focus group interview was employed for this phase. Focus groups involved a total of 26 participants selected across the three districts in the Ashanti region of Ghana. Individual interviews and focus groups were audio-recorded, transcribed, and analysed using thematic analysis.
The study found that the functioning of PPE in Ghana was quite limited at the higher levels of the health system; most PPE activities were located at the level of communities. Suboptimal functioning of PPE across the higher levels of the health system was likely to adversely affect the overall effect of PPE on health system improvement. However, the study also found that the implementation of PPE in communities significantly improved access to healthcare, promoted a responsive healthcare system, improved community-health worker relationships, improved health-seeking behaviour, enhanced community empowerment, and improved health outcomes. These positive effects could potentially be extended throughout the health system if PPE could be effectively implemented across all levels of the Ghanaian health system. The study also highlighted the role of implementing PPE in community-based health interventions and noted that widely involving user communities in the design and implementation of health programmes both improve outcomes and promotes community ownership (‘buy-in’) – thereby helping to ensure the effective sustainability of the programme beyond the implementation phase.
Also, findings were synthesised into various factors that impede or enhance the successful implementation of PPE in Ghana. The identified barriers and facilitators were categorised according to health system levels. Whilst key suggestions were offered to improve the barriers, further recommendations were also provided to leverage the key facilitators to improve PPE in Ghana including providing adequate budgetary support for PPE across all levels of the health system.
Overall, this study contributes new knowledge by providing in-depth information about the effect of PPE in improving the Ghanaian health system. It also identifies key strategies that are important for PPE implementation, especially within the context of underdeveloped healthcare settings. Finally, the study makes recommendations in response to the identified important factors facilitating or impeding the successful implementation of PPE.