title: Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana's Community-based Health Planning and Services (CHPS).
abstract: BACKGROUND
  Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana.
  
  
  METHODS
  This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones.
  
  
  RESULTS
  The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a broader expertise and training of the CHOs.
  
  
  CONCLUSIONS
  Access to improved urban health services remains a challenge. However, current policy guidelines for the implementation of a primary health model based on rural experiences and experimental design requires careful review and modifications to meet the needs of the urban settings.
authors.affiliation: School of Public Health, University of Ghana, P O Box LG 13, Legon, Accra, Ghana. adongophilip@yahoo.com.
authors.forename: Philip Baba
authors.initials: PB
authors.lastname: Adongo
authors.forename: James F
authors.initials: JF
authors.lastname: Phillips
authors.forename: Moses
authors.initials: M
authors.lastname: Aikins
authors.forename: Doris Afua
authors.initials: DA
authors.lastname: Arhin
authors.forename: Margaret
authors.initials: M
authors.lastname: Schmitt
authors.forename: Adanna U
authors.initials: AU
authors.lastname: Nwameme
authors.forename: Philip Teg-Nefaah
authors.initials: PT
authors.lastname: Tabong
authors.forename: Fred N
authors.initials: FN
authors.lastname: Binka
mesh_terms: D003152:Community Health Nursing / Q000458:organization & administration; D003153:Community Health Services / Q000458:organization & administration / Q000600:supply & distribution; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000458:organization & administration*; D004059:Diffusion of Innovation; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D005869:Ghana; D006268:Health Facilities / Q000600:supply & distribution; D006285:Health Planning; D006291:Health Policy; D006801:Humans; D008297:Male; D010560:Personnel Selection; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services; D019037:Urban Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D014838:Volunteers / Q000193:education / Q000458:organization & administration