Community Health Impact Assessment in Ghana: Contemporary Concepts and Practical Methods

It has long been recognized that health and its determinants are strongly influenced by policies, programs, and projects outside of the health care sector. Few countries have introduced health impact assessments (HIA) to try and ensure that probable impacts on health are considered. An appropriate health impact assessment regime will identify negative and positive impacts of proposed health policies and programs on health, enable the interpretation of health risk and potential health gain, and present the information to assist in decision making. These HIAs are often generic and rapid desk-based appraisals characterized by the use of information and evidence that is already available or easily accessible and generally undertaken by administrators in an organization to gain a snapshot of the health impacts to inform proposal direction. Rapid and generic desk-based assessments require less-intensive effort and resources and draws on existing data sources from scientific peer-reviewed and gray literature to analyze potential health impacts. However, both sources can also be used to determining whether a more detailed review is necessary. The Community HIA model proposed by this work departs from the generic and rapid desk-based appraisals and is intended to provide practical evidence to give higher priority to people's viewpoints, promote participation, understanding and incorporate community voices to help shape future policy, programs, and practice. A comprehensive review of Ghana's National Health Insurance Scheme (NHIS) was carried out using the generic desk-based HIA approach. This was followed by a practical qualitative community field work. In this research, we have demonstrated how community HIA is to be conducted through an actual case study in the Ghanaian West African context. The scope of this work is wide and incorporates the consideration of key concepts and possible methods for carrying out HIA at the community level.