National Scale-up Steering Groups: Are they necessary in PERFORM2Scale in Ghana?

25 Jun 2019

Professor Moses Aikins, of  the School of Public Health, University of Ghana and member of the Country Research Team, talks about the role of the National Scale-Up Steering Group in the Ghanaian strand of PERFORM2Scale.

The PERFORM2Scale project is designed to use a problem-based approach to management strengthening of district health management teams (DHMTs) for public health systems in developing countries. Thus, district health management teams are challenged to think strategically and to be ‘entrepreneurial’ within their resource and authority constraints.

PERFORM2Scale aims to strengthen DHMTs’ capacity to strategically make best use of available resources in the face of health workforce constraints such as shortages, frequent transfers and heavy work schedules. The project, which works in Malawi and Uganda as well as Ghana, has proposed the formation of a National Scale-up Steering Group (NSSG) in each country. The aim of the NSSG is to provide the institutional support for the horizontal scale-up of the intervention. Is the NSSG essential for providing oversight for this innovative and evolving management capacity building scale up approach in the health sector?

Who are they?

The Ghanaian NSSG is chaired by the Deputy Director General of Ghana Health Service, with the other five members being:

  • Eastern Regional Director of Health Service,
  • Human Resource Directorate, Ghana Health Service,
  • Director, Health Research and Development Division, Ghana Health Service,
  • a representative of Policy Planning Monitoring and Evaluation, Ministry of Health, and
  • Deputy Director of Christian Health Association of Ghana (CHAG).

They held their first meeting on 20th December 2017 at the School of Public Health, College of Health Sciences, University of Ghana, Legon.  At this meeting, the NSSG selected the first group of three districts (DG1) and the three-member resource team (RT) was formed to support and eventually take over the implementation of the management strengthening interventions (MSI). Since that meeting, the NSSG receives regular updates from the project’s Country Research Team (CRT).

Does the NSSG they have any role in PERFORM2Scale at all?

The group’s main role is:

  1. to provide technical advice to the research team,
  2. act as a sounding board for emerging issues throughout the research,
  3. provide a mechanism for research communication,
  4. operate on behalf of the user organisations (i.e. MOH, GHS, CHAG) to interface with CRT and RT, and
  5. facilitate vertical scale-up of the management strengthening interventions.

I personally think, in summary, that the NSSG is to ensure vertical scale-up of the MSI throughout the country which seems cumbersome but doable.

An African lady with a pink top and glasses speaks into a microphone

Reflection - do I personally consider the NSSG relevant for this scale-up?

Since the formation of the NSSG, the majority of the members have keenly participated in the activities of PERFORM2Scale at both the national and district levels by attending meetings and workshops when invited. They have also sometimes proactively phoned to find out how we are doing.

Their relevance in guiding the scale-up of MSI implementation in the Eastern region is in no doubt, however, vertical and country-wide scale-up will be dependent on contextual and unforeseen political exigencies of the health sector. Working with such busy, high-level public officers is a daunting task.  The difficulty is in bringing them together due to their busy and ‘revolving’ schedules and unplanned and ad hoc meetings. This requires regular and flexible alternative means of communicating and keeping them updated.

Take home notes

Clearly, in this initial stage of PERFORM2Scale, the NSSG has shown commitment which will support better acceptance and ownership of the MSI approach to action plan execution and resultant spontaneous and vertical scale-ups in the future.  But this will, to a large extent, depend upon the acceptance of the MSI approach by other key stakeholders, strategic alignment of the plan to the national agenda and the NSSG’s ability to support the intervention.

Ghana Scale-up