Learning From Navrongo

by Eric Zuehlke, web communications manager

Navrongo, a rural district in northern Ghana that faced high infant and under-5 mortality and where women averaged over 5 children each 20 years ago, was the focus of an innovative and influential public health project from the early 1990s to 2002. Based on the network and infrastructure of an existing vitamin A supplementation program that had started in 1989, the project was ambitious and wide-ranging. It included providing bed nets for malaria prevention, treating and preventing anemia in pregnancy, restructuring the way health services were delivered, combating Female Genital Mutilation, providing family planning services, and more. In a few years, quality health services were available for the first time and the fertility rate and under-5 and infant mortality rates had declined sharply.

Dr. Fred Binka, the former director of the Navrongo Health Research Centre and current professor at the School of Public Health at the University of Ghana joined a panel of Ghanian Ministry of Health officials and researchers at the PopPov conference to discuss the Navrongo project and its wide-ranging effects. Three points struck me from the panel presentation and discussion:

One of the most interesting aspects to the program was how much success differed depending on whether the community had only nurses, only volunteers, or a combination of both. It turns out that communities that used both volunteers and nurses had much higher rates of contraceptive use and fertility decline and better health outcomes than communities that relied on only nurses or volunteers. According to Binka, volunteers were mostly male and were able to communicate with husbands about family planning. Male involvement was crucial in increasing contraceptive use and increasing family planning use. Nurses, on the other hand, were instrumental in lowering mortality rates, as people began to seek out nurses and rely on them for professional health care.

Another unique aspect to the project was that health centers were built after services were already being delivered and behaviors had changed, not before. The physical building was seen as a “reward” as opposed to a prerequisite to health change. The focus remained on the community, its needs, and use of services as opposed to buildings.

The involvement of the community at all levels was instrumental to its success. From the beginning of the project, dialogue with the community was used not only to get buy-in from residents but also to learn from the community about everything from their health needs to how they constructed buildings to plan for their involvement in building future health centers. There’s been a mixture of success and challenges in scaling-up and replicating the model in other places, but as James Phillips of Columbia University said in response to a question regarding why the Matlab model in Bangladesh didn’t work in Ghana, the problem was that “there are very few Bangladeshis in Ghana.” In other words, local context means everything. Top-down models can’t simply be copied.

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